Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study

Christina Boesgaard Graversen,1 Jan Brink Valentin,2 Mogens Lytken Larsen,3 Sam Riahi,1,3 Teresa Holmberg,4 Søren Paaske Johnsen2 1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 2Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg U...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Boesgaard Graversen C, Brink Valentin J, Lytken Larsen M, Riahi S, Holmberg T, Paaske Johnsen S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	acute coronary syndrome social inequality major adverse cardiovascular event non-persistence to medication register-based cohort study. Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/117ca9c7b8544f89b5b1da705947125a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:117ca9c7b8544f89b5b1da705947125a
record_format	dspace
spelling	oai:doaj.org-article:117ca9c7b8544f89b5b1da705947125a2021-11-14T19:00:30ZNon-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study1179-1349https://doaj.org/article/117ca9c7b8544f89b5b1da705947125a2021-11-01T00:00:00Zhttps://www.dovepress.com/non-persistence-with-medication-as-a-mediator-for-the-social-inequalit-peer-reviewed-fulltext-article-CLEPhttps://doaj.org/toc/1179-1349Christina Boesgaard Graversen,1 Jan Brink Valentin,2 Mogens Lytken Larsen,3 Sam Riahi,1,3 Teresa Holmberg,4 Søren Paaske Johnsen2 1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 2Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 3Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark; 4National Institute of Public Health, University of Southern Denmark, Copenhagen, DenmarkCorrespondence: Christina Boesgaard Graversen Email c.graversen@rn.dkAim: Low socioeconomic status is associated with higher risk of major adverse cardiovascular events (MACE) among patients with incident acute coronary syndrome (ACS). We examined whether non-persistence with antiplatelet and statin therapy mediated the income- and educational-related inequality in risk of MACE.Methods: Using national registers, all Danish patients diagnosed with incident ACS from 2010 to 2017 were identified. The primary outcome (MACE) comprised all-cause death, cardiac death and cardiac readmission. Risk of MACE was handled by discrete time analyses using inverse probability of treatment weights. The mediator variable comprised non-persistence to a combined 2-dimensional measure of statin and antiplatelet treatment. The mediation analysis was evaluated by population average effects.Results: The study population was 45,874 patients, of whom 16,958 (37.0%) were non-persistent with medication and 16,365 (35.7%) suffered MACE during the median follow-up of 3.5 years. Compared to patients with low income, the adjusted hazard ratio of MACE was lowered by 33% (HR: 0.67, 95% CI: 0.61– 0.72) in men and by 34% (HR: 0.66, 95% CI: 0.61– 0.72) in women with high income, respectively. Similar results were observed according to level of education. A socioeconomic difference in risk of non-persistence was found in men but not women and only in relation to income. The lower risk of non-persistence observed in high-income men mediated the lower risk of MACE by 12.6% (95% CI: 11.1– 14.1%) compared with low-income men.Conclusion: Non-persistence with medication mediated some of the income-related inequality in risk of MACE in men, but not women, with incident ACS.Keywords: acute coronary syndrome, social inequality, major adverse cardiovascular event, non-persistence with medication, register-based cohort studyBoesgaard Graversen CBrink Valentin JLytken Larsen MRiahi SHolmberg TPaaske Johnsen SDove Medical Pressarticleacute coronary syndromesocial inequalitymajor adverse cardiovascular eventnon-persistence to medicationregister-based cohort study.Infectious and parasitic diseasesRC109-216ENClinical Epidemiology, Vol Volume 13, Pp 1071-1083 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute coronary syndrome social inequality major adverse cardiovascular event non-persistence to medication register-based cohort study. Infectious and parasitic diseases RC109-216
spellingShingle	acute coronary syndrome social inequality major adverse cardiovascular event non-persistence to medication register-based cohort study. Infectious and parasitic diseases RC109-216 Boesgaard Graversen C Brink Valentin J Lytken Larsen M Riahi S Holmberg T Paaske Johnsen S Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
description	Christina Boesgaard Graversen,1 Jan Brink Valentin,2 Mogens Lytken Larsen,3 Sam Riahi,1,3 Teresa Holmberg,4 Søren Paaske Johnsen2 1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 2Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 3Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark; 4National Institute of Public Health, University of Southern Denmark, Copenhagen, DenmarkCorrespondence: Christina Boesgaard Graversen Email c.graversen@rn.dkAim: Low socioeconomic status is associated with higher risk of major adverse cardiovascular events (MACE) among patients with incident acute coronary syndrome (ACS). We examined whether non-persistence with antiplatelet and statin therapy mediated the income- and educational-related inequality in risk of MACE.Methods: Using national registers, all Danish patients diagnosed with incident ACS from 2010 to 2017 were identified. The primary outcome (MACE) comprised all-cause death, cardiac death and cardiac readmission. Risk of MACE was handled by discrete time analyses using inverse probability of treatment weights. The mediator variable comprised non-persistence to a combined 2-dimensional measure of statin and antiplatelet treatment. The mediation analysis was evaluated by population average effects.Results: The study population was 45,874 patients, of whom 16,958 (37.0%) were non-persistent with medication and 16,365 (35.7%) suffered MACE during the median follow-up of 3.5 years. Compared to patients with low income, the adjusted hazard ratio of MACE was lowered by 33% (HR: 0.67, 95% CI: 0.61– 0.72) in men and by 34% (HR: 0.66, 95% CI: 0.61– 0.72) in women with high income, respectively. Similar results were observed according to level of education. A socioeconomic difference in risk of non-persistence was found in men but not women and only in relation to income. The lower risk of non-persistence observed in high-income men mediated the lower risk of MACE by 12.6% (95% CI: 11.1– 14.1%) compared with low-income men.Conclusion: Non-persistence with medication mediated some of the income-related inequality in risk of MACE in men, but not women, with incident ACS.Keywords: acute coronary syndrome, social inequality, major adverse cardiovascular event, non-persistence with medication, register-based cohort study
format	article
author	Boesgaard Graversen C Brink Valentin J Lytken Larsen M Riahi S Holmberg T Paaske Johnsen S
author_facet	Boesgaard Graversen C Brink Valentin J Lytken Larsen M Riahi S Holmberg T Paaske Johnsen S
author_sort	Boesgaard Graversen C
title	Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
title_short	Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
title_full	Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
title_fullStr	Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
title_full_unstemmed	Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study
title_sort	non-persistence with medication as a mediator for the social inequality in risk of major adverse cardiovascular events in patients with incident acute coronary syndrome: a nationwide cohort study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/117ca9c7b8544f89b5b1da705947125a
work_keys_str_mv	AT boesgaardgraversenc nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy AT brinkvalentinj nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy AT lytkenlarsenm nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy AT riahis nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy AT holmbergt nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy AT paaskejohnsens nonpersistencewithmedicationasamediatorforthesocialinequalityinriskofmajoradversecardiovasculareventsinpatientswithincidentacutecoronarysyndromeanationwidecohortstudy
_version_	1718428966354681856

Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study

Ejemplares similares