Trends and Determinants of Self-reported Aspirin Use Among Patients With Diabetes Stratified by Presence and Risk of Cardiovascular Diseases: A Repeated Pan-Canadian Cross-sectional Study.

OBJECTIVES: Our aim in this study was to quantify the prevalence over time and identify determinants of acetylsalicylic acid (ASA) use in patients with diabetes with and without cardiovascular disease (CVD) in a representative Canadian sample from 2005 to 2014, and to determine whether the use of ASA among patients with diabetes changed after the Diabetes Canada clinical practice guidelines updates. METHODS: Data from the Canadian Community Health Survey were used. Respondents who were at least 35 years of age and diagnosed with diabetes---not during pregnancy---were included and categorized into secondary prevention (previous heart disease or stroke) or primary prevention (high or low CVD risk) groups. A stratified and weighted multivariable logistic regression model was used to quantify ASA use and identify determinants of use. RESULTS: Our sample consisted of 15,100 respondents with diabetes (weighted sample of ∼2,429,900). Approximately 70% and 50% of Canadians with diabetes used ASA for secondary and primary prevention, respectively. Overall, the trend of ASA use was stable over the study period in both the secondary and the primary prevention groups. This trend did not change after the clinical practice guidelines update in 2008. Having a regular doctor and older age were associated with increased use of ASA. Other significant determinants independently associated with ASA use included income, body mass index, smoking, immigration status, gender and chronic diseases. CONCLUSIONS: Among patients with diabetes in Canada, ASA appears to be underutilized in secondary prevention and high-risk primary prevention populations. Future research should address whether regular use of ASA is associated with clinical outcomes among patients with diabetes.

The Impact of Prescription Medication Cost Coverage on Oral Medication Use for Hypertension and Type 2 Diabetes Mellitus.

BACKGROUND: No previous study, to the best of our knowledge, has examined both the time trend and impact of not having insurance or prescription medication cost coverage (PMCC) on the usage of type 2 diabetes and hypertension oral medications in Ontario and New Brunswick, Canada. METHODS: We used data from the Canadian Community Health Survey (CCHS) from 2007 to 2014 to examine the time trend and impact of PMCC. A multivariable-adjusted logistic regression model was fitted. RESULTS: The pseudo-cohort included 23,215 individuals representing a population of approximately 8.7 million people. Overall, 20.0% of respondents reported absence of PMCC. This proportion increased slightly from 19.6% (95% confidence interval [CI] 95% CI [17.5, 22.5]) to 20.7% (95% CI [16.9, 23.1]). Adjusted odds ratios (OR) showed that uninsured individuals were 23% less likely to use their medications (OR = 0.77, 95% CI [0.657, 0.911]). CONCLUSION: There was a slight decline in PMCC over time and this decline was associated with reduced use of medications for type 2 diabetes and hypertension.