The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project
Background In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD...
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| Veröffentlicht in: | The American heart journal 2009-04, Vol.157 (4), p.709-715.e1 |
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| creator | Niu, Shaoli, MD Zhao, Dong, MD, PhD Zhu, Junren, MD Liu, Jun, BS Liu, Qun, MD, PhD Liu, Jing, MD, MPH Wang, Wei, MD Smith, Sidney C., MD |
| description | Background In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients. Methods A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed. Results In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and β-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for β-blockers after adjustment for various cofactors. Conclusions Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES. |
| doi_str_mv | 10.1016/j.ahj.2008.12.009 |
| format | Article |
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This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients. Methods A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed. Results In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and β-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for β-blockers after adjustment for various cofactors. Conclusions Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2008.12.009</identifier><identifier>PMID: 19332200</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Acute coronary syndromes ; Aged ; Aspirin ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; China - epidemiology ; Cholesterol ; Coronary Disease - economics ; Coronary Disease - epidemiology ; Coronary Disease - prevention & control ; Coronary heart disease ; Cross-Sectional Studies ; Disease prevention ; Drug therapy ; Evidence-Based Medicine - methods ; Female ; Heart ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Hypertension ; Male ; Medical sciences ; Middle Aged ; Morbidity ; Mortality ; Neighborhoods ; Older people ; Patients ; Per capita ; Platelet Aggregation Inhibitors - therapeutic use ; Population ; Prognosis ; Risk Assessment - methods ; Risk factors ; Secondary Prevention - methods ; Socioeconomic Factors ; Statins ; Survival Rate ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use</subject><ispartof>The American heart journal, 2009-04, Vol.157 (4), p.709-715.e1</ispartof><rights>Mosby, Inc.</rights><rights>2009 Mosby, Inc.</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Apr 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-19a1da0c27b7c2ed8ce2a82a31138714c5d858127cfbf4fa0d4c7c3b998dd0cf3</citedby><cites>FETCH-LOGICAL-c464t-19a1da0c27b7c2ed8ce2a82a31138714c5d858127cfbf4fa0d4c7c3b998dd0cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870308010557$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21416204$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19332200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Niu, Shaoli, MD</creatorcontrib><creatorcontrib>Zhao, Dong, MD, PhD</creatorcontrib><creatorcontrib>Zhu, Junren, MD</creatorcontrib><creatorcontrib>Liu, Jun, BS</creatorcontrib><creatorcontrib>Liu, Qun, MD, PhD</creatorcontrib><creatorcontrib>Liu, Jing, MD, MPH</creatorcontrib><creatorcontrib>Wang, Wei, MD</creatorcontrib><creatorcontrib>Smith, Sidney C., MD</creatorcontrib><creatorcontrib>on behalf of BRIG project</creatorcontrib><creatorcontrib>BRIG project</creatorcontrib><title>The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients. Methods A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed. Results In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and β-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for β-blockers after adjustment for various cofactors. Conclusions Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.</description><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Aspirin</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>China - epidemiology</subject><subject>Cholesterol</subject><subject>Coronary Disease - economics</subject><subject>Coronary Disease - epidemiology</subject><subject>Coronary Disease - prevention & control</subject><subject>Coronary heart disease</subject><subject>Cross-Sectional Studies</subject><subject>Disease prevention</subject><subject>Drug therapy</subject><subject>Evidence-Based Medicine - methods</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Hypertension</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neighborhoods</subject><subject>Older people</subject><subject>Patients</subject><subject>Per capita</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Population</subject><subject>Prognosis</subject><subject>Risk Assessment - methods</subject><subject>Risk factors</subject><subject>Secondary Prevention - methods</subject><subject>Socioeconomic Factors</subject><subject>Statins</subject><subject>Survival Rate</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9klFv0zAUhQMCsTL4AbwgIwSChxTbSRMHJCRWoJs0CbSNZ8u1bxZ3jV1st9P-PTdttUlD8BTZ-c65x_bJsheMjhll1YfFWHWLMadUjBkfU9o8zEaMNnVe1WX5KBtRSnkualocZE9jXOCy4qJ6kh2wpig46kYPXl10QFSMXluVrHdkDukawJFhx4P2zvdWk5hUWkfiW9LZyy4PNl6RFQrApUiubeqI9sE7FW5IByokYmwEFdHaGZJwRAqgUo84CSrB1gk21oDTkM8RNKQHY7V1QFof_uUWh0Bm2F8F2KDbkNg6Mu2sUx_JGcT1EgO1wffbqUfBmkvrLreLmVoRxKfHX8n5rc_Pv33Iu6Ozk9l7_OUXoNOz7HGrlhGe77-H2a_v3y6mx_npj9nJ9MtprsuqTDlrFDOKal7Pa83BCA1cCa4KxgpRs1JPjJgIxmvdztuyVdSUutbFvGmEMVS3xWH2due7Cv73GmKSvY0alkvlwK-jrGoqKipqBF_fAxd-HRxmk2xCy0lDheBIsR2lg48xQCtXwfZ4ZMmoHNojFxLbI4f2SMYltgc1L_fO6zk-x51iXxcE3uwBFbVatkE5beMtx1nJKk5L5D7tOMAL21gIMmo7vLWxAa9UGm__G-PzPbVeWmdx4BXcQLw7rYwokOdDzYeWU0EZnUzq4g9hXfxs</recordid><startdate>20090401</startdate><enddate>20090401</enddate><creator>Niu, Shaoli, MD</creator><creator>Zhao, Dong, MD, PhD</creator><creator>Zhu, Junren, MD</creator><creator>Liu, Jun, BS</creator><creator>Liu, Qun, MD, PhD</creator><creator>Liu, Jing, MD, MPH</creator><creator>Wang, Wei, MD</creator><creator>Smith, Sidney C., MD</creator><general>Mosby, Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090401</creationdate><title>The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project</title><author>Niu, Shaoli, MD ; Zhao, Dong, MD, PhD ; Zhu, Junren, MD ; Liu, Jun, BS ; Liu, Qun, MD, PhD ; Liu, Jing, MD, MPH ; Wang, Wei, MD ; Smith, Sidney C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-19a1da0c27b7c2ed8ce2a82a31138714c5d858127cfbf4fa0d4c7c3b998dd0cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Aspirin</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>China - epidemiology</topic><topic>Cholesterol</topic><topic>Coronary Disease - economics</topic><topic>Coronary Disease - epidemiology</topic><topic>Coronary Disease - prevention & control</topic><topic>Coronary heart disease</topic><topic>Cross-Sectional Studies</topic><topic>Disease prevention</topic><topic>Drug therapy</topic><topic>Evidence-Based Medicine - methods</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Hypertension</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Neighborhoods</topic><topic>Older people</topic><topic>Patients</topic><topic>Per capita</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Population</topic><topic>Prognosis</topic><topic>Risk Assessment - methods</topic><topic>Risk factors</topic><topic>Secondary Prevention - methods</topic><topic>Socioeconomic Factors</topic><topic>Statins</topic><topic>Survival Rate</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Niu, Shaoli, MD</creatorcontrib><creatorcontrib>Zhao, Dong, MD, PhD</creatorcontrib><creatorcontrib>Zhu, Junren, MD</creatorcontrib><creatorcontrib>Liu, Jun, BS</creatorcontrib><creatorcontrib>Liu, Qun, MD, PhD</creatorcontrib><creatorcontrib>Liu, Jing, MD, MPH</creatorcontrib><creatorcontrib>Wang, Wei, MD</creatorcontrib><creatorcontrib>Smith, Sidney C., MD</creatorcontrib><creatorcontrib>on behalf of BRIG project</creatorcontrib><creatorcontrib>BRIG project</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Research Library (ProQuest)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Niu, Shaoli, MD</au><au>Zhao, Dong, MD, PhD</au><au>Zhu, Junren, MD</au><au>Liu, Jun, BS</au><au>Liu, Qun, MD, PhD</au><au>Liu, Jing, MD, MPH</au><au>Wang, Wei, MD</au><au>Smith, Sidney C., MD</au><aucorp>on behalf of BRIG project</aucorp><aucorp>BRIG project</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>157</volume><issue>4</issue><spage>709</spage><epage>715.e1</epage><pages>709-715.e1</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients. Methods A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed. Results In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and β-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for β-blockers after adjustment for various cofactors. Conclusions Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19332200</pmid><doi>10.1016/j.ahj.2008.12.009</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute coronary syndromes Aged Aspirin Biological and medical sciences Cardiology. Vascular system Cardiovascular Cardiovascular disease China - epidemiology Cholesterol Coronary Disease - economics Coronary Disease - epidemiology Coronary Disease - prevention & control Coronary heart disease Cross-Sectional Studies Disease prevention Drug therapy Evidence-Based Medicine - methods Female Heart Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypertension Male Medical sciences Middle Aged Morbidity Mortality Neighborhoods Older people Patients Per capita Platelet Aggregation Inhibitors - therapeutic use Population Prognosis Risk Assessment - methods Risk factors Secondary Prevention - methods Socioeconomic Factors Statins Survival Rate Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use |
| title | The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project |
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