Publikationer pr. år
Publikationer pr. år
Christina Boesgaard Graversen, Jan Brink Valentin, Mogens Lytken Larsen, Sam Riahi, Teresa Holmberg, Søren Paaske Johnsen
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review
Aim: Low socioeconomic status is associated with higher risk of major adverse cardiovascular events (MACE) among patients with incident acute coronary syndrome (ACS). We examined whether non-persistence with antiplatelet and statin therapy mediated the income- and educational-related inequality in risk of MACE.
Methods: Using national registers, all Danish patients diagnosed with incident ACS from 2010 to 2017 were identified. The primary outcome (MACE) comprised all-cause death, cardiac death and cardiac readmission. Risk of MACE was handled by discrete time analyses using inverse probability of treatment weights. The mediator variable comprised non-persistence to a combined 2-dimensional measure of statin and antiplatelet treatment. The mediation analysis was evaluated by population average effects.
Results: The study population was 45,874 patients, of whom 16,958 (37.0%) were non-persistent with medication and 16,365 (35.7%) suffered MACE during the median follow-up of 3.5 years. Compared to patients with low income, the adjusted hazard ratio of MACE was lowered by 33% (HR: 0.67, 95% CI: 0.61-0.72) in men and by 34% (HR: 0.66, 95% CI: 0.61-0.72) in women with high income, respectively. Similar results were observed according to level of education. A socioeconomic difference in risk of non-persistence was found in men but not women and only in relation to income. The lower risk of non-persistence observed in high-income men mediated the lower risk of MACE by 12.6% (95% CI: 11.1-14.1%) compared with low-income men.
Conclusion: Non-persistence with medication mediated some of the income-related inequality in risk of MACE in men, but not women, with incident ACS.
Originalsprog | Engelsk |
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Tidsskrift | Clinical Epidemiology |
Vol/bind | 13 |
Sider (fra-til) | 1071-1083 |
Antal sider | 13 |
ISSN | 1179-1349 |
DOI | |
Status | Udgivet - 13 nov. 2021 |
Publikation: Ph.d.-afhandling