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Utilization of cardiovascular medicines and cardiovascular mortality in Lithuania, Sweden and Norway in 2003-2012
Ingrida Lisauskienė1, Kristina Garuolienė2, Jolanta Gulbinovič3
1Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Insights
Increased cardiovascular medicine use strongly correlates with reduced cardiovascular mortality across Lithuania, Sweden, and Norway. This association was influenced by factors like alcohol consumption and hospital bed availability, highlighting the importance of comprehensive health strategies.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Economics
Background:
- Cardiovascular disease remains a leading cause of mortality globally.
- Understanding the impact of cardiovascular medicine utilization on mortality is crucial for public health policy.
- Variations in healthcare systems and socioeconomic factors may influence cardiovascular outcomes.
Purpose of the Study:
- To investigate the association between cardiovascular medicine utilization and cardiovascular mortality in Lithuania, Sweden, and Norway from 2003-2012.
- To identify population, socioeconomic, and health system factors associated with cardiovascular mortality.
- To explore the interplay between medicine use, mortality, and these influencing factors.
Main Methods:
- Ecological study design analyzing data from 2003-2012.
- Cardiovascular drug utilization quantified using Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology (DDD/TID).
- Multiple linear regression models used to assess relationships between cardiovascular-standardized death rates (CV-SDR), medicine utilization, and various socioeconomic, population, and health system factors.
Main Results:
- Higher cardiovascular medicine utilization in Sweden and Norway correlated with significant declines in CV-SDR.
- Lithuania showed increasing medicine use but a substantially higher CV-SDR.
- A strong inverse correlation (R²=0.67) was found between CV medicine utilization (DDD/TID) and CV-SDR, with nine other factors showing significant correlation.
Conclusions:
- A strong negative correlation exists between cardiovascular medicine utilization and cardiovascular mortality across the studied countries.
- Factors such as lower unemployment, higher alcohol consumption, and increased hospital beds amplified the mortality-reducing effect of cardiovascular medicines.
- These findings underscore the complex relationship between medication use, health system factors, and cardiovascular health outcomes.
Objective:
The aim of this ecological study was to evaluate whether any changes in cardiovascular (CV) medicine utilization, population, socioeconomic and health system factors were associated with CV mortality in Lithuania, Sweden and Norway in 2003-2012.
Materials And Methods:
CV drug utilization was calculated using the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology and expressed as a number of DDD per 1000 inhabitants per day (DDD/TID). The CV age-standardized death rate (CV-SDR) and risk factors data were obtained from the WHO, EUROSTAT, and FAOSTAT databases. The multiple linear regression model was used for modeling outcome measures - the relationship between the CV-SDR and CV medicine utilization including socioeconomic (GDP, unemployment and divorce rate), population (alcohol consumption, smoking and amount of kcal per day, consumption of fruit and vegetables, health status self-evaluation) and health system factors (number of hospital beds, practicing physicians and health care expenditure).
Results:
The higher CV medicine utilization in Sweden (307-455 DDD/TID, P<0.001) and Norway (306-394 DDD/TID, P<0.001) was associated with a definite decline in CV-SDR (in Norway from 215 to 146 and in Sweden from 233 to 174). In Lithuania, the increasing but lower consumption of CV medicines (135-360 DDD/TID, P<0.001) and twice higher CV-SDR (from 541 to 447) was registered. A significant inverse correlation was observed between CV-SDR and DDD/TID. We found a strong association between the DDD/TID and the CV-SDR (R2=0.67, P<0.001). There was a strong correlation between CV-SDR and nine factors (P<0.05), except the number of practicing physicians, amount of kcal per day. There was a strong correlation between DDD/TID and nine factors (P<0.05), except the unemployment rate and amount of kcal per day. Association between an increase in the use of medicines and a decrease in CV-SDR was stronger in the case of higher alcohol consumption, higher number of available beds in hospitals and the lower unemployment rate.
Conclusions:
We confirmed the strong negative correlation between CV medicine utilization and CV mortality in all countries. The strong correlation was found between CV-SDR and nine factors, also between the use of CV medicines and nine factors. The impact of factors on the medicines induced decrease in CV-SDR showed the stronger influence in case of lower unemployment, higher alcohol consumption and higher number of beds for hospitalization.
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