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Healthcare delivery, economics and global health
Original research
Cross-sectional analysis of educational inequalities in primary prevention statin use in UK Biobank
  1. Alice Rose Carter1,2,
  2. Dipender Gill3,4,5,6,7,
  3. George Davey Smith1,2,8,
  4. Amy E Taylor2,8,
  5. Neil M Davies1,2,9,
  6. Laura D Howe1,2
  1. 1 Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  2. 2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  3. 3 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  4. 4 Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK
  5. 5 Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford, UK
  6. 6 Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London, UK
  7. 7 Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London, UK
  8. 8 NIHR Bristol Biomedical Research Centre, Bristol, UK
  9. 9 K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  1. Correspondence to Dr Alice Rose Carter, Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; alice.carter{at}bristol.ac.uk

Abstract

Objective Identify whether participants with lower education are less likely to report taking statins for primary cardiovascular prevention than those with higher education, but an equivalent increase in underlying cardiovascular risk.

Methods Using data from a large prospective cohort study, UK Biobank, we calculated a QRISK3 cardiovascular risk score for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female participants; mean age 56 years). We used logistic regression to explore the association between (i) QRISK3 score and (ii) educational attainment on self-reported statin use. We then stratified the association between QRISK3 score and statin use, by educational attainment to test for interactions.

Results There was evidence of an interaction between QRISK3 score and educational attainment. Per unit increase in QRISK3 score, more educated individuals were more likely to report taking statins. In women with ≤7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (OR 1.07, 95% CI 1.07 to 1.07). In women with ≥20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14 to 1.15). Comparable ORs in men were 1.04 (95% CI 1.04 to 1.05) for ≤7 years of schooling and 1.08 (95% CI 1.08, 1.08) for ≥20 years of schooling.

Conclusion Per unit increase in QRISK3 score, individuals with lower educational attainment were less likely to report using statins, likely contributing to health inequalities.

  • statins
  • epidemiology
  • electronic health records
  • risk factors

Data availability statement

Data may be obtained from a third party and are not publicly available. The derived variables have been returned to UK Biobank for archiving. The code used to derive QRISK3 scores and carry out analyses is available at: github.com/alicerosecarter/statin_inequalities.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2021-319238

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The derived variables have been returned to UK Biobank for archiving. The code used to derive QRISK3 scores and carry out analyses is available at: github.com/alicerosecarter/statin_inequalities.

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    Footnotes

    • NMD and LDH contributed equally.

    • Contributors ARC designed the study, cleaned and analysed the data, interpreted the results, wrote and revised the manuscript. DG advised on defining medications, interpreted the results and critically reviewed and revised the manuscript. GDS, AET, NMD and LDH all designed the study, interpreted the results, critically reviewed and revised the manuscript and provided supervision for the project. NMD and LDH contributed equally and are joint senior authors on this manuscript. ARC and LDH serve as guarantors of the paper. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This research was conducted using the UK Biobank Resource using application 10 953. ARC is funded by the UK Medical Research Council Integrative Epidemiology Unit, University of Bristol (MC_UU_00011/1 and MC_UU_00011/6) and the University of Bristol British Heart Foundation Accelerator Award (AA/18/7/34219). ARC, GDS, AET, NMD and LDH work in a unit that receives core funding from the UK Medical Research Council and University of Bristol (MC_UU_00011/1). DG is supported by the British Heart Foundation Centre of Research Excellence (RE/18/4/34215) at Imperial College London and a National Institute for Health Research Clinical Lectureship at St. George’s, University of London (CL-2020-16-001). AET and GDS are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at University Hospitals Bristol NHS Foundation and the University of Bristol. The Economics and Social Research Council support NMD via a Future Research Leaders grant (ES/N000757/1) and a Norwegian Research Council grant number 295 989. LDH is funded by a Career Development Award from the UK Medical Research Council (MR/M020894/1).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No funding body has influenced data collection, analysis or its interpretations.

    • Competing interests DG is employed part-time by Novo Nordisk.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.