Cross-sectional analysis of educational inequalities in primary prevention statin use in UK Biobank

Alice R Carter*, Dipender Gill, George Davey Smith, Amy E Taylor, Neil M Davies, Laura D Howe

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
59 Downloads (Pure)

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; mean age, 56). We used logistic regression to explore the association between i) QRISK3 score and ii) educational attainment on self-report 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 (odds ratio (OR)(1.07, 95% CI 1.07, 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, 1.15). Comparable ORs in men were 1.04 (95% CI 1.04, 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.
Original languageEnglish
Pages (from-to)536-542
Number of pages7
JournalHeart
Volume108
Issue number7
Early online date27 Jul 2021
DOIs
Publication statusPublished - 10 Mar 2022

Bibliographical note

Funding Information:
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).

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Keywords

  • Inequalities
  • cardiovascular disease
  • statins
  • education
  • QRISK

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