Initiation rates of statin therapy for the primary prevention of cardiovascular disease: an assessment of differences between countries of the UK and between regions within England

Abstract

Objectives: To investigate the extent to which variation exists in the initiation rate of statin therapy for the primary prevention of cardiovascular disease between countries of the UK and between different regions within England.

Design: Cohort study using data from a large UK primary care database.

Setting uk participants: 4,820,885 individuals from 554 general practices during the period 2004-2012.

Main outcome measures: Rate of statin therapy initiation per 1000 person-years.

Results: Relative to a fixed English rate of 1 initiation per 1000 person-years and accounting for gender, age and social deprivation level, the rate was similar for Scotland at 0.92 (95% CI 0.84 to 1.00) and rates for Northern Ireland and Wales were higher at 1.40 (95% CI 1.20 to 1.62) and 1.18 (95% CI 1.05 to 1.32), respectively. Within England, the regions could be classified into three groups with respect to statin therapy initiation rates (relative to a rate of 1 initiation per 1000 person-years for London): the South Central 0.73 (95% CI 0.64 to 0.83), South West 0.80 (95% CI 0.71 to 0.91), East of England 0.81 (95% CI 0.71 to 0.94) and South East Coast 0.83 (95% CI 0.73 to 0.95); strategic health authorities had similar low rates followed by the East Midlands 0.88 (95% CI 0.73 to 1.05), West Midlands 0.96 (95% CI 0.84 to 1.09), North East 0.96 (95% CI 0.79 to 1.16), Yorkshire and Humber 0.97 (95% CI 0.81 to 1.17) and London strategic health authorities. North West England exhibited the highest rate of statin therapy initiation of 1.16 (95% CI 1.02 to 1.31).

Conclusions: Considerable variation in the rate of statin therapy initiation was observed between the four countries of the UK and between different geographical regions within England.

Keywords: CARDIOLOGY; PREVENTIVE MEDICINE; PRIMARY CARE.

Figure 1

Plot showing the estimated statin therapy initiation rate for each of the 554 general practitioner practices. The solid red line indicates the sample mean statin therapy initiation rate. The dashed red lines indicate this sample mean±2SD(sample SD).

Figure 2

Plot showing the estimated statin therapy initiation rate for each of the 554 general practitioner practices, stratified by UK country. The solid red line indicates the sample mean statin therapy initiation rate within a country. The dashed red lines indicate this sample mean ±2SD(sample SD) within a country.

Figure 3

Plot showing the statin initiation rate for each practice, stratified by strategic health authority (indicated by an icon for each practice). The solid red lines show the estimate of the statin initiation rate using data from within a strategic health authority. The dashed red lines indicate sample mean ±2SD(sample SD) within a strategic health authority (EM, East Midlands; NE, North East; NW, North West; SCen, South Central; SECoast, South East Coast; SW, South West; WM, West Midlands).