Relationship between Statin Utilization and Socioeconomic Deprivation in Hungary

Abstract

The risk of premature mortality caused by cardiovascular diseases (CVDs) is approximately three times higher in the Central Eastern European region than in high income European countries, which suggests a lack and/or ineffectiveness of preventive interventions against CVDs. The aim of the present study was to provide data on the relationship between premature CVD mortality, statin utilization as a preventive medication and socioeconomic deprivation at the district level in Hungary. As a conceptually new approach, the prescription of statins, the prescription redemption and the ratio between redemption and prescription rates were also investigated. The number of prescriptions for statins and the number of redeemed statin prescriptions were obtained from the National Health Insurance Fund Administration of Hungary for each primary healthcare practice for the entire year of 2012. The data were aggregated at the district level. To define the frequency of prescription and of redemption, the denominator was the number of the 40+-year-old population adjusted by the rates of 60+-year-old population of the district. The standardized mortality rates, frequency of statin prescriptions, redeemed statin prescriptions, and ratios for compliance in relation to the national average were mapped using the “disease mapping” option, and their association with deprivation (tertile of deprivation index as a district-based categorical covariate) was defined using the risk analysis capabilities within the Rapid Inquiry Facility. The risk analysis showed a significant positive association between deprivation and the relative risk of premature cardiovascular mortality, and a reverse J-shaped association between the relative frequency of statin prescriptions and deprivation. Districts with the highest deprivation showed a low relative frequency of statin prescriptions; however, significantly higher primary compliance (redemption) was observed in districts with the highest deprivation. Our data clearly indicate that insufficient statin utilization is strongly linked to the so-called physician-factor, i.e., a statin prescription. Consequently, statin treatment is poor and represents a significant barrier to reducing mortality, particularly among people living in highly deprived areas of the country.

The decade of Roma Inclusion: did it make a difference to health and use of health care services?

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High Inequalities Associated With Socioeconomic Deprivation in Cardiovascular Disease Burden and Antihypertensive Medication in Hungary

“…The method for calculating DI values and their usefulness in identifying SES-related inequalities in CVD mortality were described previously (Juhász et al, 2010 ), and it was successfully used in previous studies designed to characterize the association between deprivation and mortality amenable to healthcare (Nagy et al, 2012 ), between deprivation and premature mortality due to alcoholic liver disease (Nagy et al, 2014 ) and between deprivation and statin utilization in Hungary (Boruzs et al, 2016 ). Briefly, the DI is based on seven municipality-level elementary socioeconomic indicators, including income, level of education, rate of unemployment, rate of one-parent families, rate of large families, density of housing and car ownership.…”

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