Abstract 854: Cholesterol Control in Patients With a History of Hyperlipidemia and Established Vascular Disease Reflects National Economic/Health System Characteristics
Background and Objectives: The REACH Registry is an international prospective registry of outpatients at risk of atherothrombosis due to established coronary artery (CAD), cerebrovascular (CVD) and/or peripheral arterial disease (PAD), or >= 3 risk factors. REACH enrolled 67,888 patients from 44 countries. Previous reports revealed an underutilization of lipid lowering therapy throughout all geographic regions. We examined the influence of country-level economic and health system characteristics on baseline cholesterol control (total cholesterol <<26>200mg/dl) in patients with a history of hyperlipidemia and established vascular disease, after adjusting for patient-level characteristics and country.
Methods: Hierarchical generalized linear models were used to examine the influence of the following factors on cholesterol control: gross national income per capita (GNI), % gross domestic product spent on health (GDP-HEALTH), government health expenditure as percentage of total health expenditure (GOVT-HEALTH), out-of-pocket health expenditure as percentage of private health expenditure (OOP-HEALTH), and World Health Organization indices of health system achievement (WHO-ACHIEVE) and performance/efficiency (WHO-PERFORM). All models were adjusted for patient demographic and clinical characteristics; country was included as a random effect.
Results: Higher GNI, WHO-ACHIEVE and WHO-PERFORM increased the likelihood of successful cholesterol control, and higher GDP-HEALTH was associated with a marginally significant increase. Higher OOP-HEATH was associated with a lower rate of cholesterol control.
Conclusions: Country-level economic indicators and health system characteristics are associated with successful cholesterol control in patients with a history of hyperlipidemia and established vascular disease. Higher out-of-pocket health expenditures adversely affect cholesterol control.