Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2013;66:803-11 - Vol. 66 Num.10 DOI: 10.1016/j.rec.2013.05.025

Socioeconomic Status and Health Inequalities for Cardiovascular Prevention Among Elderly Spaniards

Cília Mejía-Lancheros a, Ramón Estruch b,c, Miguel A. Martínez-González d, Jordi Salas-Salvadó c,e, Dolores Corella c,f, Enrique Gómez-Gracia g, Miquel Fiol c,h, José Lapetra c,i, Maria I. Covas c,j, Fernando Arós k, Lluís Serra-Majem l, Xavier Pintó m, Josep Basora c,n, José V. Sorlí c,o,p, Miguel A. Muñoz a,q,

a Departamento de Pediatría, Obstetricia, Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
b Departamento de Medicina Interna, IDIBAPS, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
c CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
d Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, Navarra, Spain
e Departamento de Nutrición Humana, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
f Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
g Departamento de Medicina Preventiva, Universidad de Málaga, Málaga, Spain
h Instituto de Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Baleares, Spain
i Departamento de Medicina de Familia, División de Atención Primaria de Sevilla, Centro de Salud Bellavista, Sevilla, Spain
j Unidad de Lípidos e Investigación en Epidemiología Cardiovascular, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
k Departamento de Cardiología, Hospital Universitario Txagorritxu, Vitoria, Álava, Spain
l Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
m Unidad de Lípidos y Riesgo Vascular, Medicina Interna, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
n Unidad de Investigación en Atención Primaria de Tarragona, Institut Català de la Salut e IDIAP-Jordi Gol, Tarragona, Spain
o Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
p División de Atención Primaria, Instituto de la Salud de Valencia, Valencia, Spain
q Unitat de Suport a la Recerca, División de Atención Primaria de Salud, Institut Català de la Salut e IDIAP-Jordi Gol, Barcelona, Spain

Keywords

Cardiovascular disease. Cardiovascular risk factor. Pharmacological treatment. Socioeconomic inequalities. Life styles.

Abstract

Introduction and objectives

Although it is known that social factors may introduce inequalities in cardiovascular health, data on the role of socioeconomic differences in the prescription of preventive treatment are scarce. We aimed to assess the relationship between the socioeconomic status of an elderly population at high cardiovascular risk and inequalities in receiving primary cardiovascular treatment, within the context of a universal health care system.

Methods

Cross-sectional study of 7447 individuals with high cardiovascular risk (57.5% women, mean age 67 years) who participated in the PREDIMED study, a clinical trial of nutritional interventions for cardiovascular prevention. Educational attainment was used as the indicator of socioeconomic status to evaluate differences in pharmacological treatment received for hypertension, diabetes, and dyslipidemia.

Results

Participants with the lowest socioeconomic status were more frequently women, older, overweight, sedentary, and less adherent to the Mediterranean dietary pattern. They were, however, less likely to smoke and drink alcohol. This socioeconomic subgroup had a higher proportion of coexisting cardiovascular risk factors. Multivariate analysis of the whole population found no differences between participants with middle and low levels of education in the drug treatment prescribed for 3 major cardiovascular risk factors (odds ratio [95% confidence interval]): hypertension (0.75 [0.56-1.00] vs 0.85 [0.65-1.10]); diabetic participants (0.86 [0.61-1.22] vs 0.90 [0.67-1.22]); and dyslipidemia (0.93 [0.75-1.15] vs 0.99 [0.82-1.19], respectively).

Conclusions

In our analysis, socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention in elderly patients in Spain. Free, universal health care based on a primary care model can be effective in reducing health inequalities related to socioeconomic status.

1885-5857/© 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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