Racial and ethnic disparities in statin adherence: insights from the All of Us Research Program

Background: Statin adherence impacts cardiovascular outcomes, yet disparities persist. Understanding the sociodemographic factors and barriers is crucial for targeted interventions. Objective: To investigate the relationship between sociodemographic factors and statin adherence across racial and ethnic groups. Design: This retrospective study examined sociodemographic factors, prescription records, clinical factors, and responses from the Demographic, Drug Exposure, Healthcare Utilization Survey (HUS) in the All of Us (AoU) cohort. Multivariable logistic regression models were used to assess the impact of sociodemographic factors on adherence stratified by race. Participants: Adult participants with statin prescription records. Subgroup analyses included those who responded to the HUS. Exposures: Statin prescription. Main outcomes and measures: We calculated percent days covered (PDC) as the proportion of days within a year in which a person prescribed a statin filled a prescription. Adequate adherence was defined as PDC ≥ 80%. Results: Among the 17,029 adults with a statin prescription, the mean PDC was 57%, and 66% had PDC ≤ 80%. In multivariable analyses stratified by race and ethnicity, distinct barriers to adherence emerged. Among the non-Hispanic White participants, barriers to consistent healthcare [odds ratio (OR) = 0.60, 95% CI (0.42-0.87)] and lack of provider identity concordance [OR = 0.83, 95% CI (0.72-0.97)] were associated with lower adherence. In the non-Hispanic Black participants, Medicare [OR = 0.54, 95% CI (0.32-0.90)] and Veterans Affairs insurance [OR = 0.44, 95% CI (0.20-0.96)], as well as financial barriers [OR = 0.69, 95% CI (0.51-0.96)], reduced adherence. Among the Hispanic participants, provider-related anxiety [OR = 0.13, 95% CI (0.02-0.87)], immigrant status [OR = 0.25, 95% CI (0.08-0.72)], and Medicaid coverage [OR = 0.11, 95% CI (0.03-0.45)] predicted lower adherence. Conclusions and relevance: Addressing cardiovascular disease disparities requires recognizing unique sociodemographic barriers to statin adherence within racial and ethnic groups. Our findings highlight the need for tailored strategies considering the diverse barriers each group faces. Targeted interventions can bridge adherence gaps and improve cardiovascular outcomes across populations. This approach recognizes that although race and ethnicity may correlate with specific barriers, the underlying social determinants of health often play the key role in statin adherence.