Résumé :
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[BDSP. Notice produite par INIST-CNRS VJ8t6R0x. Diffusion soumise à autorisation]. Objective : To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education. Design and setting : Linkage of individuals through national registers of hospitalisations, drug dispensation, income and education. Participants : 30 078 patients aged 30-74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001. Main outcome measures : Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in treatment lasting at least 90 days, and re-initiation of treatment after a break). Results : When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30-64 years, high income (adjusted hazard ratio (HR) 1.27 ; 95% confidence interval (Cl) 1.19-1.35) and medium income (HR 1.13 ; 95% Cl 1.06-1.20) was associated with initiation of statin treatment compared with low income. The risk of break in statin treatment was lower for patients with high (HR 0.73 ; 95% Cl 0.66-0.82) and medium (HR 0.82 ; 95% Cl 0.74-0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment. Conclusion : Patients with low compared with high income less frequently initiated preventive treatment post-AMI, had worse long-term persistency with statins, but tended to have better persistency with beta-blockers. Low income by itself seems not to be associated with poor long-term refill persistency post-AMI.
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