Objective: To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education.
Design and setting: Linkage of individuals through national registers of hospitalisations, drug dispensation, income and education.
Participants: 30 078 patients aged 30–74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001.
Main outcome measures: Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in treatment lasting at least 90 days, and re-initiation of treatment after a break).
Results: When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30–64 years, high income (adjusted hazard ratio (HR) 1.27; 95% confidence interval (CI) 1.19–1.35) and medium income (HR 1.13; 95% CI 1.06–1.20) was associated with initiation of statin treatment compared with low income. The risk of break in statin treatment was lower for patients with high (HR 0.73; 95% CI 0.66–0.82) and medium (HR 0.82; 95% CI 0.74–0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment.
Conclusion: Patients with low compared with high income less frequently initiated preventive treatment post-AMI, had worse long-term persistency with statins, but tended to have better persistency with beta-blockers. Low income by itself seems not to be associated with poor long-term refill persistency post-AMI.
- acute myocardial infarction
- income and education
- initiation and persistency
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The study sponsors had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Competing interests: Several of the authors have given industry-sponsored lectures and taken part in clinical trials sponsored by the industry, but there are no specific conflicts of interest related to the current article.
Ethical approval: The project did not require approval by the regional committee on biomedical research ethics.