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International Journal for Equity in Health

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Open Access 01-12-2017 | Systematic review

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

Authors: Karice K. Hyun, David Brieger, Mark Woodward, Sarah Richtering, Julie Redfern

Published in: International Journal for Equity in Health | Issue 1/2017

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.

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Title: The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis
Authors: Karice K. Hyun
David Brieger
Mark Woodward
Sarah Richtering
Julie Redfern
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-017-0658-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

PROSPERO Registry

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

PROSPERO Registry

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