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. 2023 Sep;41(3):297-305.
doi: 10.1080/02813432.2023.2234439. Epub 2023 Jul 19.

Are doctors using more preventive medication for cardiovascular disease? A Swedish cross-sectional study

Joel Lillqvist  1 , Johan N Sommar  2 , Per E Gustafsson  3 , Eva-Lotta Glader  2 , Katarina Hamberg  1 , Olov Rolandsson  1
Affiliations

Are doctors using more preventive medication for cardiovascular disease? A Swedish cross-sectional study

Joel Lillqvist et al. Scand J Prim Health Care. 2023 Sep.

Abstract

Background: Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner.

Aim: To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians.

Design and setting: This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45-74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013.

Method: Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income.

Results: MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59-1.72).

Conclusion: We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians.

Keywords: Healthcare inequities; cardiovascular disease; epidemiology; pharmacoepidemiology; prevention.

Plain language summary

KEYPOINTSGroups with low socioeconomic status have lower rates of using medication that prevents cardiovascular disease, compared to groups with high socioeconomic status.Physicians are responsible for prescribing all medicines to prevent cardiovascular disease; thus, biased prescriptions could have effects on the equality of care in the population.Compared to individuals with equivalent education, physicians had higher rates of using medication that prevents cardiovascular disease.This study highlights the need for systematic population-based evaluation of CVD risk in order to promote equitable CVD outcomes.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of the population selected for the calculation of the main outcome.
Figure 2.
Figure 2.
The likelihoods that physicians will receive treatment, compared to non-physicians. Values are odds ratios and (95% confidence intervals).
Figure 3.
Figure 3.
The likelihood that physicians will receive treatment, compared to non-physicians, is stratified by 5-year age groups. Values are the odds ratios (95% confidence intervals) and the interaction odds ratios (95% confidence intervals).
See this image and copyright information in PMC

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