03440nas a2200589   4500000000100000008004100001100001700042700001700059700002000076700001800096700001800114700002200132700002300154700002100177700001600198700001800214700002900232700001900261700002300280700001600303700001700319700001500336700002000351700002100371700001900392700001900411700001600430700001900446700001500465700002000480700001700500700001700517700001900534700001700553700001500570700001100585700001200596700002200608700001700630700001400647700001800661700001900679700001800698700001300716700002100729700001100750245014700761300001400908490000600922520190800928022001402836       2018                            d1 aMcKee Martin1 aCorsi Daniel1 aChifamba Jephat1 aIqbal Romaina1 aYusoff Khalid1 aIsmail Noorhassim1 aZatonska Katarzyna1 aRosengren Annika1 aDiaz Rafael1 aAvezum Alvaro1 aLopez-Jaramillo Patricio1 aLanas Fernando1 aRangarajan Sumathy1 aYusuf Salim1 aYeates Karen1 aChow Clara1 aMurphy Adrianna1 aPalafox Benjamin1 aO'Donnell Owen1 aStuckler David1 aPerel Pablo1 aAlHabib Khalid1 aBai Xiulin1 aDagenais Gilles1 aDans Antonio1 aErbakan Ayse1 aKelishadi Roya1 aKhatib Rasha1 aLear Scott1 aLi Wei1 aLiu Jia1 aMohan Viswanathan1 aMonsef Nahed1 aMony Prem1 aPuoane Thandi1 aSchutte Aletta1 aSintaha Mariz1 aTeo Koon1 aWielgosz Andreas1 aYin Lu00aInequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study.  ae292-e3010 v63 a<p><b>BACKGROUND: </b>There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development.</p><p><b>METHODS: </b>We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated.</p><p><b>FINDINGS: </b>The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines.</p><p><b>INTERPRETATION: </b>Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications.</p><p><b>FUNDING: </b>Full funding sources listed at the end of the paper (see Acknowledgments).</p>  a2214-109X