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Disparities in Statin Use for Prevention of ASCVD
Quick Takes
- Disparities in statin use for primary prevention included lower use of statins among non-Hispanic Black men and non-Mexican Hispanic women.
- Among adults eligible for statins for secondary prevention, significantly lower rates of statin use were observed for non-Hispanic Black men, other/multiracial men, non-Mexican Hispanic women, non-Hispanic White women, and non-Hispanic Black women.
- These disparities were not explained by measurable differences in disease severity or access to resources and, therefore, may be partially mediated by care process factors, including bias, stereotyping, and mistrust.
Study Questions:
What are the estimated differences in statin use by race/ethnicity and gender, which are not explained by medical appropriateness of therapy or structural factors?
Methods:
The investigators used a cross-sectional study design to examine the use of statins among eligible adults based on the 2013 and 2018 American College of Cardiology and American Heart Association blood cholesterol guidelines. Data from the National Health and Nutrition Examination Survey (NHANES; 2015–2020) were used for the present analysis. Participants were grouped by race/ethnicity and gender. The Institute of Medicine framework was used to calculate adjusted prevalence ratios (aPRs) to estimate disparities in statin use, adjusting for age, disease severity, access to health care, and socioeconomic status with non-Hispanic White men as the reference group. The primary outcome of interest was statin use.
Results:
Data from a total of 13,213 participants enrolled in NHANES and between the ages of 21–75 years were included for the primary prevention analysis. The indications for primary prevention were one or more of the following: low-density lipoprotein cholesterol of ≥190 mg/dL (7.5%), diabetes (25.8%), or 10-year ASCVD risk of ≥7.5% (87.6%). A total of 1,138 participants, representing 16,548,722 people, were eligible to receive a statin for secondary prevention of ASCVD complications, including one or more history of angina (25.5%), coronary heart disease (45.2%), myocardial infarction (41.8%), or stroke (38.1%).
For primary prevention, a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors was observed for non-Hispanic Black men (aPR, 0.73 [95% CI, 0.59-0.88]) and non-Mexican Hispanic women (aPR, 0.74 [CI, 0.53-0.95]). For secondary prevention, a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors was observed for non-Hispanic Black men (aPR, 0.81 [CI, 0.64-0.97]), other/multiracial men (aPR, 0.58 [CI, 0.20-0.97]), Mexican American women (aPR, 0.36 [CI, 0.10-0.61]), non-Mexican Hispanic women (aPR, 0.57 [CI, 0.33-0.82), non-Hispanic White women (aPR, 0.69 [CI, 0.56-0.83]), and non-Hispanic Black women (aPR, 0.75 [CI, 0.57-0.92]).
Conclusions:
The authors concluded that disparities in statin use for several race–ethnicity–gender groups are not explained by measurable differences in medical appropriateness of therapy, access to health care, and socioeconomic status. These residual disparities may be partially mediated by unobserved processes contributing to health inequity, including bias, stereotyping, and mistrust.
Perspective:
Although cross-sectional, these data provide evidence of the significantly lower rates of statin use among certain race–ethnicity–gender groups. Statin-related disparities remained after adjustment for factors such as age, disease severity, and access to health care, suggesting the need for training and systems which reduce such disparities.
Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins
Keywords: African Americans, Angina Pectoris, Atherosclerosis, Cholesterol, LDL, Coronary Disease, Diabetes Mellitus, Ethnic Groups, Health Services Accessibility, Hispanic Americans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, Mexican Americans, Minority Health, Myocardial Infarction, Primary Prevention, Race Factors, Secondary Prevention, Socioeconomic Factors, Stroke, Vascular Diseases
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