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Meta-Analysis
. 2017 Aug 31;16(1):162.
doi: 10.1186/s12939-017-0658-z.

The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis

Karice K Hyun  1   2   3 , David Brieger  4 , Mark Woodward  5   6 , Sarah Richtering  7 , Julie Redfern  5
Affiliations
Meta-Analysis

The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis

Karice K Hyun et al. Int J Equity Health. .

Abstract

Background: There are varying data on whether socioeconomic status (SES) affects the treatment in patients with acute coronary syndrome (ACS). Our aim was to obtain a reliable estimate of the effect of SES on discharge prescription of medications following an ACS through systematic review and meta-analysis.

Methods: Medline, EMBASE and Global Health were searched systematically on 6th April 2016. Studies were eligible if the participants had ACS and reported the rate/odds of guideline-recommended ACS medications prescription (aspirin, antiplatelet, beta blocker, angiotensin co-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and statin) at discharge stratified by SES. A meta-analysis was performed to pool the estimates, comparing the prescription ratio (PR) between the lowest and the highest SES groups.

Results: Of 252 articles found from the search, seven met the eligibility criteria and it included 41,462 (20,986 from the lowest SES group) patients. We found that the individual/neighbourhood level SES did not affect the prescription of aspirin (PR (95% CI): 0.97 (0.91, 1.03)), but for beta blocker and statin, the lowest SES group were disadvantaged (0.84 (0.73, 0.94), 0.80 (0.62, 0.98), respectively). In contrast, ACEi were prescribed more often to the lowest individual/neighbourhood level SES group than the highest (1.13 (1.05, 1.22)). Although the risk of bias was low, there was considerable heterogeneity between the studies.

Conclusions: Despite the recommendations to close the treatment gap, the rate of prescription of guideline-recommended medications in managing ACS is significantly different between patients with the lowest and the highest groups. A solution is needed to provide equitable care across the SES groups.

Prospero registry: Systematic review registration no.: CRD42016048503. Registered 28 September 2016.

Keywords: Acute coronary syndrome; Health inequity; In-hospital care; Medication prescription; Socioeconomic status; Systematic review.

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Competing interests

The author(s) declare(s) that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection. ACS: acute coronary syndrome; ACEi: angiotensin co-enzyme inhibitors
Fig. 2
Fig. 2
Meta-analysis of the effect of socioeconomic status (lowest vs. highest) on prescription of aspirin. CI: confidence interval
Fig. 3
Fig. 3
Meta-analysis of the effect of socioeconomic status (lowest vs. highest) on prescription of beta blocker. CI: confidence interval
See this image and copyright information in PMC

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