Journal of Public Health Advance Access originally published online on October 27, 2006
Journal of Public Health 2007 29(1):40-47; doi:10.1093/pubmed/fdl068
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner ‘Quality and Outcomes Framework’
M. Ashworth, Honorary Senior Lecturer1
D. Lloyd, Applied Statistician2
R. S. Smith, GIS Analyst3
A. Wagner, Research Fellow4
G. Rowlands, Professor of Primary Care and Public Health5
1 Department of General Practice and Primary Care, King’s College London School of Medicine at Guy’s, King’s College and St Thomas’ Hospitals, 5 Lambeth Walk, London SE11 6SP, UK
2 Prescribing Support Unit, The Information Centre for Health and Social Care, 1 Trevelyan Square, Boar Lane, Leeds LS1 6AE, UK
3 Informatics Collaboratory of the Social Sciences (ICOSS), University of Sheffield, 219 Portobello, Sheffield S1 4DP, UK
4 National Primary Care Research and Development Centre, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK
5 Faculty of Health, London South Bank University, 103 Borough Road, London SE1 0AA, UK
Address correspondence to Mark Ashworth, E-mail: mark.ashworth{at}kcl.ac.uk
We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004–05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.
Keywords: primary care quality indicators, social deprivation, statin prescribing