Identifying high cholesterol in the ambulance setting: a mixed-methods cohort study to tackle health inequality
Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours. A mixed-met...
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| Published in: | Journal of public health (Oxford, England) Vol. 46; no. 2; pp. 277 - 285 |
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29-05-2024
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| Abstract | Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours.
A mixed-methods study between January and December 2022. Patients aged ≥40 years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed.
Of 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol ≥5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide.
Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours. |
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| AbstractList | Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours.
A mixed-methods study between January and December 2022. Patients aged ≥40 years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed.
Of 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol ≥5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide.
Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours. BACKGROUNDIndividuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours.METHODSA mixed-methods study between January and December 2022. Patients aged ≥40 years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed.RESULTSOf 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol ≥5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide.CONCLUSIONSUndiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours. |
| Author | Rees, Jon Charlton, Karl Burrow, Emma |
| Author_xml | – sequence: 1 givenname: Karl orcidid: 0000-0002-9601-1083 surname: Charlton fullname: Charlton, Karl organization: Research & Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK – sequence: 2 givenname: Jon orcidid: 0000-0002-3295-244X surname: Rees fullname: Rees, Jon organization: Helen McArdle Research Institute and Sunderland City Council, School of Psychology, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK – sequence: 3 givenname: Emma surname: Burrow fullname: Burrow, Emma organization: Research & Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK |
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| Cites_doi | 10.1111/hex.12991 10.1080/09581596.2020.1851654 10.3390/ijerph19138023 10.1111/j.1532-5415.2011.03597.x 10.1186/s12889-015-1352-y 10.1177/0022146510386794 10.1016/j.pop.2012.11.003 10.1093/eurheartj/ehz455 10.1093/bmb/ldaa008 10.1111/acem.13220 10.1136/bmjopen-2015-009984 10.1038/s41591-022-02158-7 10.1136/bmjopen-2021-058951 10.3399/bjgp18X696365 10.1136/jech-2020-214401 10.1111/1467-9566.12866 |
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| Keywords | pre-hospital emergency care health behaviour lipids public health |
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