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Health care delivery, economics and global health care
Original research article
Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs
  1. Mitsuyo Kinjo1⇑,
  2. Edward Chia-Cheng Lai2,
  3. Maarit Jaana Korhonen3,
  4. Rita L McGill4 and
  5. Soko Setoguchi5
  1. 1Department of Medicine, Rheumatology, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
  2. 2School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  3. 3Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
  4. 4Department of Medicine, Nephrology, The University of Chicago, Chicago, USA
  5. 5Department of Epidemiology, Rutgers School of Public Health, New Brunswick, USA
  1. Correspondence to Dr Mitsuyo Kinjo; kinjomitsuyo{at}gmail.com

Abstract

Objectives Healthy user bias arises when users of preventive medications such as lipid-lowering drugs (LLDs), hormone replacement therapy and antihypertensive (AH) medications are healthier than non-users due to factors other than medication effects, making the medications appear more beneficial in observational studies of effectiveness and safety. The purpose of the study is to examine factors contributing to healthy user effect in patients taking AHs or LLDs.

Methods Among patients with hypertension or hyperlipidaemia in a population-based sample from the National Health and Nutrition Examination Survey (1999–2010), we assessed the association between socioeconomic and lifestyle factors and the use of AHs/LLDs by logistic regression with adjustment for demographics and comorbidities in a cross-sectional study.

Results When 9715 AH/LLD users were compared with 3725 non-users, AH/LLD users were more likely to be: highly educated (OR 1.2, 95% CI 1.2 to 1.3), non-impoverished (OR 1.3, 95% CI 1.2 to 1.4), current non-smokers (OR 1.2, 95% CI 1.1 to 1.4), physically active (OR 1.1, 95% CI 1.0 to 1.2) and consume more calcium (OR 1.1, 95% CI 1.0 to 1.3) but less likely to have normal body mass index (OR 0.6, 95% CI 0.6 to 0.7) or to meet dietary sodium recommendations (OR 0.8, 95% CI 0.7 to 0.9).

Conclusions We identified several salutary lifestyle factors associated with AH/LLD use in a representative US population. Healthy user effect may be partly explained by better socioeconomic profiles and lifestyles in AH/LLD users compared with non-users.

  • Healthy user effect
  • antihypertensive drugs
  • lipid lowering drugs

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000417

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    Footnotes

    • Contributors All authors had access to the data and a role in writing the manuscript.

    • Funding No Funding

    • Ethics approval Ethics approval

    • Data sharing statement Data sharing statement