Statin prescribing in Nottingham general practices: a cross-sectional study

Background The aim of the study was to determine the effect of deprivation on variations in statin prescribing in Nottingham general practices. Depriv ation is used as a measure of population cardiovascular morbidity and need for statin treatment. The setting was all 118 general practices in contract with Nottingham Health Authority. Methods A cross-sectional study was undertaken. Statin prescribing in gener al practice during 1996 was related to indices of practice deprivation base d on enumeration district (ED) level data from the 1991 Census. The relatio nship between statin prescribing per 1000 patients aged 35-69 and practice deprivation (measured both as Townsend score and as Jarman UPA(8) score) wi th additional adjustment for practice characteristics (number of partners, training status, total list size, fundholding status) cardiovascular prescr ibing costs net of lipid prescribing and hospital activity (total and medic al admissions and new general practitioner total and medical out-patient re ferrals) for each practice. Results The prescription of statins during 1996 varied between nil and 14.1 'statin-years' of prescribing per 1000 patients aged 35-69. There was a si gnificant inverse relationship between the rate of statin prescribing and t he level of deprivation of that practice (p<0.0001). Deprivation, as measur ed by Townsend index, accounted for 13 per cent of the total variability in statin prescribing, which rose to 19 per cent after adjustment. The prescr ibing of other lipid lowering agents of the fibrate class was positively as sociated with statin prescribing (p=0.001) and this association persisted a fter adjusting for deprivation. None of the other practice characteristics were found to be significantly associated with rates of statin prescribing. Conclusions General practices with high deprivation indices serve more depr ived populations with a higher prevalence of cardiovascular disease, and ma y be assumed to have a greater need for statins. Despite this, practices wi th higher deprivation indices prescribed fewer statins to their patients th an less deprived practices. It was not possible to identify whether the mor e deprived general practices had successfully identified at risk individual s but it is likely that special efforts are needed to increase the uptake o f effective health care in their patients.