Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease

Introduction Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these health indicators in the population diagnosed with hypertension. Objectives The objective of this study was to measure and compare prevalence, mortality, morbidity, use of medical resources and treatments in relation to the level of material and social deprivation of the area of residence, in a population with a diagnosis of hypertension in primary prevention for cardiovascular disease (CVD) in Quebec in 2006-2007. Methods This study is based on a secondary analysis of the medical administrative data of the Quebec health insurance board, the Régie de l'assurance maladie du Québec, for a cohort of 276 793 patients aged 30 years or older who had been diagnosed with hypertension in 2006 or 2007, but who did not have a known diagnosis of CVD. The health indicators adjusted for age and sex are prevalence, death, a cardiovascular event, physician visits, emergency department visits and use of antihypertensives. Twenty-five types of areas of residence were obtained by crossing the material and social deprivation quintiles. Results Compared with patients living in materially and socially advantaged areas, those living in deprived areas were at 46% higher risk of a cardiovascular event, 47% higher risk of being frequent emergency department visitors and 31% higher risk of being frequent users of a general practitioner's services, but 25% lower risk of being frequent users of medical specialists' services. Little or no variation was observed in the use of antihypertensives. Conclusion This study reveals the existence, in a CVD primary prevention context, of large variations in a number of health indicators among hypertensive patients owing to the material and social deprivation of residential neighbourhood. It is therefore important to take the socioeconomic context into account when planning interventions to prevent CVDs and their consequences.

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Urgent Care Costs of Uncontrolled Asthma in Canada, 2004

Canadian Respiratory Journal ◽

10.1155/2005/478764 ◽

2005 ◽

Vol 12 (8) ◽

pp. 435-436 ◽

Cited By ~ 18

Author(s):

Soo Jin Seung ◽

Nicole Mittmann

Keyword(s):

Emergency Department ◽

Indirect Costs ◽

Emergency Department Visits ◽

Urgent Care ◽

Uncontrolled Asthma ◽

Physician Visits ◽

Direct And Indirect Costs ◽

Drug Treatments ◽

The Cost ◽

Care Costs

It has been more than a decade since Krahn evaluated the direct and indirect costs of asthma in Canada. Asthma is often uncontrolled and the cost of providing urgent care has not been determined. Hospitalizations, unscheduled physician visits, emergency department visits, drug treatments and ambulance rides are resources used by the uncontrolled asthmatic population, resulting in $162 million in costs annually. Improved control of asthma could decrease these costs.

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Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France

European Heart Journal ◽

10.1093/eurheartj/ehz458 ◽

2019 ◽

Vol 40 (43) ◽

pp. 3516-3525 ◽

Cited By ~ 23

Author(s):

Philippe Giral ◽

Anke Neumann ◽

Alain Weill ◽

Joël Coste

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Primary Prevention ◽

Cardiovascular Event ◽

Structural Model ◽

Medication Possession Ratio ◽

Population Based ◽

Cerebrovascular Event ◽

Increased Risk ◽

Time Varying Covariates

Abstract Aims The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment. We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention. Methods and results A population-based cohort study using French national healthcare databases was performed, studying all subjects who turned 75 in 2012–14, with no history of cardiovascular disease and with a statin medication possession ratio ≥80% in each of the previous 2 years. Statin discontinuation was defined as three consecutive months without exposure. The outcome was hospital admission for cardiovascular event. The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators). A total of 120 173 subjects were followed for an average of 2.4 years, of whom 17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33 [95% confidence interval (CI) 1.18–1.50] (any cardiovascular event), 1.46 (95% CI 1.21–1.75) (coronary event), 1.26 (95% CI 1.05–1.51) (cerebrovascular event), and 1.02 (95% CI 0.74–1.40) (other vascular event). Conclusion Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly.

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Quantifying comorbidity in individuals with COPD: a population study

European Respiratory Journal ◽

10.1183/09031936.00061414 ◽

2014 ◽

Vol 45 (1) ◽

pp. 51-59 ◽

Cited By ~ 24

Author(s):

Andrea S. Gershon ◽

Graham C. Mecredy ◽

Jun Guan ◽

J. Charles Victor ◽

Roger Goldstein ◽

...

Keyword(s):

Lung Cancer ◽

Cardiovascular Disease ◽

Emergency Department ◽

Tract Infection ◽

Health Services ◽

Respiratory Tract ◽

Ambulatory Care ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Emergency Department Visits

Chronic obstructive pulmonary disease (COPD) has been associated with many types of comorbidity. We aimed to quantify the real world impact of COPD on lower respiratory tract infection, cardiovascular disease, diabetes, psychiatric disease, musculoskeletal disease and cancer, and their impact on COPD through health services.A population study using health administrative data from Ontario, Canada, in 2008–2012 was conducted. Absolute and adjusted relative rates of ambulatory care visits, emergency department visits and hospitalisations for the comorbidities of interest in people with and without COPD were determined and compared.Among 7 241 591 adults, 909 948 (12.6%) had COPD. Over half of all lung cancer, a third of all lower respiratory tract infection and cardiovascular disease, a quarter of all low trauma fracture, and a fifth of all psychiatric, musculoskeletal, non-lung cancer and diabetes ambulatory care visits, emergency department visits and hospitalisations in Ontario were used by people with COPD. Individuals with COPD used about five times more health services for lung cancer, and two times more health services for lower respiratory tract infections and cardiovascular disease than people without COPD.Individuals with COPD use a disproportionate amount of health services for comorbid disease, placing significant burden on the healthcare system.

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GW25-e5114 PM2.5 components in association with emergency department visits for hypertension-related cardiovascular disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.06.435 ◽

2014 ◽

Vol 64 (16) ◽

pp. C93 ◽

Cited By ~ 1

Author(s):

Huang Zhijun ◽

Zhou Yuqing ◽

Yuan Hong ◽

Duan Yizhu ◽

Tang Xiaohong ◽

...

Keyword(s):

Cardiovascular Disease ◽

Emergency Department ◽

Emergency Department Visits

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Impact of meteorological parameters and air pollution on emergency department visits for cardiovascular diseases in the city of Zagreb, Croatia

Archives of Industrial Hygiene and Toxicology ◽

10.1515/aiht-2016-67-2770 ◽

2016 ◽

Vol 67 (3) ◽

pp. 240-246 ◽

Cited By ~ 2

Author(s):

Sanja Pintarić ◽

Ivan Zeljković ◽

Gordana Pehnec ◽

Višnja Nesek ◽

Mislav Vrsalović ◽

...

Keyword(s):

Cardiovascular Disease ◽

Emergency Department ◽

Air Temperature ◽

Negative Correlation ◽

Significant Negative Correlation ◽

Primary Diagnosis ◽

Emergency Department Visits ◽

University Hospitals ◽

Emergency Visits ◽

Ed Visits

Abstract The aim of this study was to investigate whether nitrogen dioxide (NO2), ozone (O3), and certain meteorological conditions had an impact on cardiovascular disease (CVD)-related emergency department (ED) visits in the metropolitan area of Zagreb. This retrospective, ecological study included 20,228 patients with a cardiovascular disease as their primary diagnosis who were examined in the EDs of two Croatian University Hospitals, Sisters of Charity and Holy Spirit, in the study period July 2008-June 2010. The median of daily CVD-related ED visits during the study period was 28 and was the highest during winter. A significant negative correlation was found between CVD-related emergency visits and air temperature measured no more than three days prior to the visit, and the highest negative correlation coefficient was measured two days earlier (R=0.266, p≤0.001). The number of CVD-related emergency visits significantly correlated with the average NO2 concentration on the same day (R=0.191, p<0.001). The results of multiple stepwise regression analysis showed that the number of CVD-related emergency visits depended on air temperature, and NO2 and O3 concentrations. The higher the air temperatures, the lower the number of daily CVD-related emergency visits (p<0.001). An increase in NO2 concentrations (p=0.005) and a decrease in O3 concentrations of two days earlier (p=0.006) led to an increase in CVD-related ED visits. In conclusion, the decrease in O3 concentrations and the increase in NO2, even if below the legally binding thresholds, could be associated with an increase in CVD-related emergency visits and a similar effect was observed with lower temperature measured no more than three days prior to the visit.

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