Compared to non-Hispanic White men, statin use for primary prevention was lower among non-Hispanic Black men (aPR 0.73; 95% CI 0.59-0.88) and non-Mexican Hispanic women (aPR 0.74; 95% CI 0.53-0.95).
Cross-Sectional
Yes
Does race, ethnicity, and gender influence the likelihood of receiving guideline-recommended statin therapy in eligible patients?
Significant disparities in guideline-recommended statin use exist across race, ethnicity, and gender groups that are not explained by disease severity, healthcare access, or socioeconomic status.
Relative Risk: 0.73 (95% CI 0.59–0.88)
BACKGROUND: Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons. OBJECTIVE: To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors. DESIGN: Cross-sectional analysis. SETTING: National Health and Nutrition Examination Survey from 2015 to 2020. PARTICIPANTS: Persons eligible for statin therapy based on 2013 and 2018 American College of Cardiology/American Heart Association blood cholesterol guidelines. MEASUREMENTS: The independent variable was race-ethnicity-gender. The outcome of interest was use of a statin. Using the Institute of Medicine framework for examining unequal treatment, we calculated adjusted prevalence ratios (aPRs) to estimate disparities in statin use adjusted for age, disease severity, access to health care, and socioeconomic status relative to non-Hispanic White men. RESULTS: For primary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors among non-Hispanic Black men (aPR, 0.73 95% CI, 0.59 to 0.88) and non-Mexican Hispanic women (aPR, 0.74 CI, 0.53 to 0.95). For secondary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors for non-Hispanic Black men (aPR, 0.81 CI, 0.64 to 0.97), other/multiracial men (aPR, 0.58 CI, 0.20 to 0.97), Mexican American women (aPR, 0.36 CI, 0.10 to 0.61), non-Mexican Hispanic women (aPR, 0.57 CI, 0.33 to 0.82), non-Hispanic White women (aPR, 0.69 [CI, 0.56 to 0.83), and non-Hispanic Black women (aPR, 0.75 CI, 0.57 to 0.92). LIMITATION: Cross-sectional data; lack of geographic, language, or statin-dose data. CONCLUSION: Statin use disparities 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 that contribute to health inequity, including bias, stereotyping, and mistrust. PRIMARY FUNDING SOURCE: National Institutes of Health.
Frank et al. (Mon,) conducted a cross-sectional in Atherosclerotic cardiovascular disease prevention. Race, ethnicity, and gender vs. Non-Hispanic White men was evaluated on Use of a statin (aPR 0.73, 95% CI 0.59 to 0.88). Compared to non-Hispanic White men, statin use for primary prevention was lower among non-Hispanic Black men (aPR 0.73; 95% CI 0.59-0.88) and non-Mexican Hispanic women (aPR 0.74; 95% CI 0.53-0.95).