Journal Article

Associations between education level, blood-lipid measurements and statin treatment in a Danish primary health care population from 2000 to 2018

Flege, Marius Mølsted, Engell, Anna Elise, Jørgensen, Henrik Løvendahl, Lind, Bent Struer, Andersen, Christen Lykkegaard, Kriegbaum, Margit, Bathum, Lise

2023

Overview

To examine whether education level influences screening, monitoring, and treatment of hypercholesterolemia. Epidemiological cohort study. Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre. Cholesterol blood test results ordered by general practitioners in Greater Copenhagen were retrieved from 2000-2018. Using the International Standard Classification of Education classification, the population was categorized by length of education in three groups (basic education; up to 10 years, intermediate education; 11-12 years, advanced education; 13 years or more). The database comprised 13,019,486 blood sample results from 653,903 patients. Frequency of lipid measurement, prevalence of statin treatment, age and comorbidity at treatment initiation, total cholesterol threshold for statin treatment initiation, and achievement of treatment goal. The basic education group was measured more frequently (1.46% absolute percentage difference of total population measured [95% CI 0.86%-2.05%] in 2000 and 9.67% [95% CI 9.20%-10.15%] in 2018) over the period compared to the intermediate education group. The advanced education group was younger when receiving first statin prescription (1.87 years younger [95% CI 1.02-2.72] in 2000 and 1.06 years younger [95% CI 0.54-1.58 in 2018) compared to the intermediate education group. All education groups reached the treatment goals equally well when statin treatment was initiated. Higher education was associated with earlier statin prescription, although the higher educated group was monitored less frequently. There was no difference in reaching treatment goal between the three education groups. These findings suggest patients with higher education level achieve an earlier dyslipidemia prevention intervention with an equally satisfying result compared to lower education patients. Key Points Little is known about the role of social inequality as a possible barrier for managing hypercholesterolemia in general practice. Increasing education level was associated to less frequent measurement and less frequent statin treatment. Patients with higher education level were younger, and less comorbidity at first statin prescription. Education level had no effect on frequency of statin treatment-initiated patients reaching the treatment goal was found.

• Publisher: Taylor & Francis,Taylor & Francis LLC,Taylor & Francis Group
• Subject: Academic achievement / Biochemistry / Blood / Blood tests / Cholesterol / Classification / Cohort analysis / Cohort Studies / Comorbidity / Denmark / Education groups / Educational attainment / Educational Status / Epidemiology / Family physicians / General practice / Groups / Health care / Health services / Higher education / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Hypercholesteremia / Hypercholesterolemia / Hypercholesterolemia - drug therapy / hypolipidemic agents / Lipids / Measurement / Medical screening / Medical treatment / Metabolic disorders / Objectives / Patients / Physicians / Prevention programs / Primary care / Primary Health Care / Social inequality / Statins / Treatment Outcome