(A01) Disparities in Guideline-Recommended Pharmacotherapy for Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and Sex: A Nationally Representative Cross-Sectional Analysis of Adults in the United States
Student Department of Epidemiology, University of Pittsburgh School of Public Health, United States
Background: Individuals from racial and ethnic minority groups experience higher rates of cardiovascular disease and mortality compared to non-Hispanic White individuals in the United States. Inequalities in statin use for prevention of atherosclerotic cardiovascular disease (ASCVD) may mediate these disparities.
Objectives: We aimed to estimate disparities in statin use by race, ethnicity, and sex and to identify explanatory factors for these disparities.
Methods: We utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2015 – 2020. We identified individuals ages 21 – 75 recommended for statin therapy for primary prevention of ASCVD or secondary prevention of ASCVD complications based on 2013 and 2018 ACC/AHA Blood Cholesterol Guidelines. The main outcome of interest was use of a statin. The main exposure of interest was race-ethnicity. To account for known disparities by sex, we included a race-ethnicity*sex interaction. We chose non-Hispanic White males as the reference group because we hypothesized that they would have the highest rates of statin use, thereby highlighting potential disparities. We used sequential logistic regression models to assess the contribution of age, disease severity, medical comorbidities, access to care, and socioeconomic status to statin-use disparities. Missing covariates were imputed using multiple imputation.
Results: Out of 13,213 NHANES participants ages 21 – 75, we identified 4,750 eligible for primary prevention of ASCVD (representing 62.0 million individuals in the U.S. population) and 1,148 eligible for secondary prevention of ASCVD complications (representing 15.8 million individuals). For primary prevention, 39.4% of eligible non-Hispanic White males used statins. For others, the percentage ranged from 23.8% for non-Hispanic Black males to 41.2% for non-Hispanic White females. For secondary prevention, 71.1% of non-Hispanic White males used statins. For others, the percentage ranged from 38.0% for Other Hispanic females and non-Hispanic Black females to 74.3% for non-Hispanic Asian males. After adjustment for explanatory factors, non-Hispanic Black males had an unexplained disparity in statin use for primary prevention (aOR 0.49, 95% CI 0.31 – 0.78). Non-Hispanic White females (aOR 0.46 95% CI 0.26 – 0.81) and Other Hispanic females (aOR 0.31, 95% CI 0.12 – 0.80) had an unexplained disparity in statin use for secondary prevention relative to non-Hispanic White males.
Conclusions: This study demonstrates unexplained disparities in use of guideline recommended ASCVD pharmacotherapy by race, ethnicity, and sex after accounting for factors that commonly mediate health disparities. These results may help identify strategies to mitigate inequity in statin use.