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Inequalities I
Socioeconomic differences in statin use after deregulation of simvastatin in the UK: the Whitehall II prospective cohort study
  1. I. Forde,
  2. T. Chandola,
  3. M. G. Marmot,
  4. M. Kivimaki
  1. Department of Epidemiology and Public Health, University College London, London, UK

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    Objective

    To examine socioeconomic differences in statin use after deregulation of simvastatin in adults with moderate or high risk of coronary heart disease.

    Design

    Prospective cohort study.

    Setting

    20 civil service departments in London.

    Participants

    3631 men and women (mean age 62.7 years) with moderate or high 10-year risk of CHD according to Framingham risk score.

    Main Outcome Measures

    Statin use, both prescribed and over the counter; recall of personal CHD risk.

    Results

    Based on medical screening, 2451 participants were at high CHD risk and 1180 at moderate risk. Of the high-risk participants, 54% reported using prescribed statin. This rate did not differ between employment grades (an index of socioeconomic position) after adjusting for age and sex; South Asian participants, however, were more likely to report using prescribed statin than White participants (odds ratio 1.73, 95% CI 1.28 to 2.36). Three percent of high-risk participants reported using over the counter statin with participants from low (OR 0.11, 95% CI 0.01 to 0.88) and middle (OR 0.54, 95% CI 0.29 to 1.00) employment grades being less likely users than those from high employment grades. Among moderate-risk participants, 8% reported using over the counter statin; we found no variation by employment grade or ethnicity in this group. 37% of high-risk participants recalled their CHD risk. After adjusting for age, sex and cognitive function, South Asians were significantly less likely to recall than White participants (OR 0.65, 95% CI 0.46 to 0.93) and middle (OR 0.74, 95% CI 0.61 to 0.89) and low (OR 0.52, 95% CI 0.37 to 0.74) employment grades participants less likely to recall than those from high employment grades.

    Conclusion

    Reported use of statin is considerably lower than need in all social groups although our data suggest that use of statin has largely remained socially equitable after recent changes in availability. However, most high-risk participants are unaware of their risk, despite being informed of their risk by the study. Ethnic minorities and lower socioeconomic position groups, who are most at risk of heart disease, are significantly less likely to be aware. This is likely to impact on ability to participate in self-management and may partly explain poorer clinical outcomes.

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