Abstract 19322: Universal Health Care System: Do Inequalities In Absolute Cardiovascular Risk Exist
Background: It is well documented that cardiovascular morbidity is greater in poorer and more socially deprived areas. Several absolute cardiovascular disease (CVD) risk scores have now incorporated socioeconomic status (SES) into their score. However, there is limited information as to whether this disparity exists in countries with a universal health care system such as Australia.
Methods: The aim of the study was to determine the effect of SES on absolute CVD risk in a universal health care system. General practitioners (GPs) throughout Australia were asked to recruit patients from January to December 2008. All patients underwent an assessment of their risk factors. The Framingham Heart CVD risk equation was used to determine absolute CVD risk. Australian specific socioeconomic indexes were used to measure relative SES based on GP postcodes.
Results: Overall, 1258 GPs recruited 31229 patients of which 32% (9917) of patients (42% male and 58% female) had no history of CVD. Patients in disadvantaged areas were slightly older (mean age 56.9+26.1 years compared to 53.5+30.3 years in affluent areas),and had a lower total cholesterol (TC) (186.42+44.46 mg/dl) and LDL (104.9+38.2 mg/dl) compared to patients in affluent areas (TC: 195.39+40.56 mg/dl, 95%CI -0.32- -0.15, p<0.0001) (LDL: 113.88+36.27 mg/dl, 95%CI -0.31- -0.14, p<0.0001). There was also higher prescribing of statin medication in disadvantaged areas (781, 50% vs 781, 39%; p<0.0001). The mean CVD risk in men in disadvantaged areas was 16.43+3.6 compared to 15.45+3.6 in affluent areas (95%CI 0.4-1.6, p=0.001). There was no significant difference in women. In both men and women as their CVD risk increased by 7%, their SES became more disadvantaged (95%CI -0.16- -0.03, p=0.005 in men; 95%CI -0.16- -0.04, p=0.001 in women). This was partly attributable to a higher prevalence of smoking in people in disadvantaged areas (199, 13%) compared to affluent areas (124, 6%; p<0.0001).
Conclusion: In this population with universal health care, there was minimal difference in absolute CVD risk between people living in disadvantaged areas compared to those living in affluent areas. However, lifestyle risk factors continue to be problematic in disadvantaged areas.
- Cardiovascular disease prevention
- Risk factors
- Patient education/teaching psychosocial aspects
- © 2010 by American Heart Association, Inc.