Aspirin use and knowledge in the community: a population- and health facility based survey for measuring local health system performance
1 Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
2 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
3 Center for Translational Science, Children’s National Health System, Washington, DC, USA
4 Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
5 Department of Pharmacy, University of Washington, Seattle, WA, USA
6 Public Health—Seattle & King County, Seattle, WA, USA
7 Department of Epidemiology, University of Washington, Seattle, WA, USA
8 Department of Global Health, University of Washington, Seattle, WA, USA
BMC Cardiovascular Disorders 2014, 14:16 doi:10.1186/1471-2261-14-16Published: 7 February 2014
Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community.
The Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for all respondents. For a subgroup free of CAD or cerebral infarction that underwent physical examination, we measured 10-year coronary heart disease risk and blood salicylate concentration.
Two in five respondents reported using aspirin routinely while one in five with a history of CAD or cerebral infarction and without contraindication did not report routine use of aspirin. Women with these conditions used less aspirin than men (65.0% vs. 76.5%) and reported more health problems that would make aspirin unsafe (29.4% vs. 21.2%). In a subgroup undergoing phlebotomy a third of respondents with low cardiovascular risk used aspirin routinely and only 4.6% of all aspirin users had no detectable salicylate in their blood.
In this large urban county where health care delivery should be of high quality, there is insufficient aspirin use among those with high cardiovascular risk or disease and routine aspirin use by many at low risk. Further efforts are needed to promote shared-decision making between patients and clinicians as well as inform the public about appropriate use of routine aspirin to reduce the burden of atherosclerotic vascular disease.