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Statin prescribing in Australia: socioeconomic and sex differences

Nigel P Stocks, Heather McElroy, Philip Ryan and James Allan
Med J Aust 2004; 180 (5): 229-231.

Summary

Objective: To assess if there are any differences in statin prescribing across Australia by socioeconomic status or sex and to relate prescribing rates to coronary heart disease (CHD) mortality rates.

Design: Cross-sectional study using data on statin prescribing by age, sex and patient postcode for the period May to December 2002.

Setting and participants: The Australian population, stratified by sex and quintile of Index of Relative Socio-Economic Disadvantage (IRSD).

Main outcome measures: Age-standardised rates of statin scripts per 1000 population per month for each sex and IRSD quintile.

Results: 9.1 million prescriptions for statins were supplied between May and December 2002, for a total cost of $570 million. The age-standardised rates for statin prescribing in women varied from 56.9 (95% CI, 56.6–57.2) scripts per 1000 population per month in the most disadvantaged socioeconomic quintile through 53.4 (95% CI, 53.0–53.7), 50.3 (95% CI, 50.0–50.6), 48.4 (95% CI, 48.1–48.7) to 46.3  (95% CI, 46.0–46.6) in the least disadvantaged quintile. For men the figures were 52.6 (95% CI, 52.3–52.9), 50.9 (95% CI, 50.6–51.2), 48.8 (95% CI, 48.6–49.1), 47.7 (95% CI, 47.4–47.9), and 51.9 (95% CI, 51.6–52.2). There was a significant linear association between statin prescribing and CHD mortality by quintile of socioeconomic disadvantage in women (weighted least squares slope, 0.380; 95% CI, 0.366 to 0.395; P < 0.0001), but not in men (slope, − 0.002; 95% CI, − 0.010 to 0.006; P = 0.65).

Conclusions: Our results suggest that in men there is either overprescribing of statins in the highest socioeconomic quintile or underprescribing in the lowest. Furthermore, contrary to expectation, women — relative to men — are prescribed statins at higher rates at lower levels of risk (using CHD deaths as a proxy measure of risk).

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  • Nigel P Stocks1
  • Heather McElroy2
  • Philip Ryan3
  • James Allan4

  • 1 Department of General Practice, University of Adelaide, Adelaide, SA.
  • 2 Department of Public Health, University of Adelaide, Adelaide, SA.
  • 3 Hills Medical Service, Adelaide, SA.

Correspondence: 

Acknowledgements: 

This research was funded by a 2002 Royal Australian College of General Practitioners (Pfizer) Cardiovascular Research Grant. It was also supported by the Primary Health Care Research, Evaluation and Development (PHCRED) Program. We wish to thank Professor George Davey-Smith and Dr John Furler, who gave comments on early drafts, and Kristyn Wilson, who assisted with data analysis.

Competing interests:

None identified.

  • 1. Bennett S. Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979–1993. Int J Epidemiol 1996; 25: 266-275.
  • 2. National Preventive and Community Medicine Committee RACGP. Guidelines for preventive activities in general practice. Aust Fam Physician 2002; 31(S1): 17-28.
  • 3. Jackson R. Guidelines on preventing cardiovascular disease in clinical practice. BMJ 2000; 320: 659-661.
  • 4. Fairhurst K, Huby G. From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia. BMJ 1998; 317: 1130-1134.
  • 5. Grover S, Lowensteyn I, Esrey K, et al. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ 1995; 310: 975-978.
  • 6. Taylor R, Chey T, Bauman A, Webster I. Socioeconomic, migrant and geographic differentials in coronary heart disease occurrence in New South Wales. Aust N Z J Public Health 1999; 23: 20-26.
  • 7. Sexton PT, Sexton TH. Excess coronary mortality among Australian men and women living outside the capital city statistical divisions. Med J Aust 2000; 172: 370-374. <MJA full text>
  • 8. Health Insurance Commission. Pharmaceutical Benefits Scheme statistical report for items 8213G, 8214H, 8215J, 8521L, 8023G, 8024H, 2833D, 2834E, 8197K, 2013Y, 2011W, 2012X, 8173E, 8313M, by scheme by state, December 2002 to November 2003. Available at: www.hic.gov.au/statistics/dyn_pbs/forms/pbs_tab1.shtml (accessed Jan 2004).
  • 9. Hippisley-Cox J, Pringle M, Crown N, et al. Sex inequalities in ischaemic heart disease in general practice: cross sectional survey. BMJ 2001; 322: 832.
  • 10. Hart JT. The inverse care law. Lancet 1971; 1: 405-412.
  • 11. Australian Bureau of Statistics. 1996 Census of Population and Housing: Socio-Economic Indexes for Areas [Information paper]. Canberra: ABS, 1998. (ABS Catalogue No. 2039.0.)
  • 12. Australian Bureau of Statistics. Population by age and sex, Australian states and territories. Canberra: ABS, 2003. (ABS Catalogue no. 3201.0.)
  • 13. Australian Institute of Health and Welfare. Heart, stroke and vascular diseases — Australian facts 2001. Cardiovascular Disease Series No. 14. Canberra: AIHW, National Heart Foundation of Australia, National Stroke Foundation of Australia, 2001. (AIHW Catalogue No. CVD13.)
  • 14. SAS [computer program]. Version 8.02. Cary, NC: SAS Institute Inc, 1999.
  • 15. Australian Bureau of Statistics. National Health Survey: summary of results. Canberra: ABS, 2001. (ABS Catalogue No. 4364.0.)
  • 16. McIsaac W, Goel V, Naylor D. Socioeconomic status and visits to physicians by adults in Ontario, Canada. J Health Serv Res Policy 1997; 2: 94-102.
  • 17. Furler JS, Harris E, Chondros P, et al. The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. Med J Aust 2002; 177: 80-83. <MJA full text>
  • 18. Commonwealth Department of Health and Aged Care. General practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care, 2000.
  • 19. Henderson J, Pan Y, Britt H, et al. Cardiovascular problems and risk behaviours among patients at general practice encounters in Australia 1998–00. General Practice Series No. 9. Canberra: AIHW, 2002. (AIHW Catalogue No. GEP 9.)
  • 20. Barter P, Best P, Boyden A, et al. Lipid management guidelines — 2001. Med J Aust 2001; 175 (Suppl): S61-S84. Available at: www.heartfoundation.com.au/downloads/lipid_guide_2001.pdf (accessed Jan 2004).
  • 21. Forge BH, Briganti EM. Lipid lowering and coronary heart disease risk: how appropriate are the national guidelines? Med J Aust 2001; 175: 471-475.
  • 22. Simons LA, Levis G, Simons J. Apparent discontinuation rates in patients prescribed lipid-lowering drugs. Med J Aust 1996; 164: 208-211.
  • 23. McElduff P, Dobson AJ. Trends in coronary heart disease — has the socioeconomic differential changed? Aust N Z J Public Health 2000; 24: 465-473.

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