Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner ‘Quality and Outcomes Framework’

Abstract

We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004-05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.

Deprivation, demography, and the distribution of general practice:

“…[22][23][24][25] This is not to deny that deprived populations may face particular disadvantages in gaining access to high quality primary care. Several studies suggest that general practices located in areas of socioeconomic deprivation provide a lower quality of care as judged by QOF scores [26][27][28][29][30] (although it should be acknowledged that other studies find little evidence of socioeconomic inequality 31,32 ). There may also be plausible reasons why, relative to underlying morbidity, deprived groups need greater access to primary care.…”

“…For example, there appears to be a greater readiness on the part of disadvantaged people to consult GPs, perhaps due to a lack of confidence in self-management. [31][32][33][34][35] This, together with higher levels of psychological distress would be expected to place higher demands on primary care practitioners working in deprived areas. 36,37 The point, then, is not to dismiss the legitimate healthcare needs that arise from deprivation but to recognise that evidence on inequalities in the provision of GPs is more complex and equivocal than implied by the Darzi interim report.…”

Effect of ethnicity on the prevalence, severity, and management of COPD in general practice

“…[21][22][23][24] The reasons for these differences are uncertain. Given the equitable access to care in the UK NHS, differential registration and access to primary and secondary care services are unlikely to play a role; differential take-up of medicines due to cost is also unlikely in this population as the majority are of retirement age and, hence, eligible for free prescriptions.…”

Risk of pneumonia in patients taking statins: population-based nested case-control study

“…Matching on age, sex, index year, and general practice removed confounding by these factors. A possible higher statin prescription rate in people with lower social deprivation 31 was accounted for by adjusting for Townsend deprivation score. Prospective recording of the exposure data before the outcome occurred eliminated recall bias.…”