TY - JOUR
T1 - Statin Eligibility and Prescribing Across Racial, Ethnic, and Language Groups over the 2013 ACC/AHA Guideline Change
T2 - a Retrospective Cohort Analysis from 2009 to 2018
AU - Heintzman, John
AU - Kaufmann, Jorge
AU - Rodriguez, Carlos J.
AU - Lucas, Jennifer A.
AU - Boston, Dave
AU - April-Sanders, Ayana K.
AU - Chung-Bridges, Katherine
AU - Marino, Miguel
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Society of General Internal Medicine.
PY - 2023/10
Y1 - 2023/10
N2 - Background: It is uncertain if the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines for the use of HMGCoA reductase inhibitors (statins) were associated with increased statin eligibility and prescribing across underserved groups. Objective: To analyze, by race, ethnicity, and preferred language, patients with indications for and presence of a statin prescription before and after the guideline change. Design: Retrospective cohort study. Setting: Multistate community health center (CHC) network with linked electronic health records. Patients: Low-income patients aged ≥ 50 with a primary care visit in 2009–2013 or 2014–2018. Main Measures: (1) Odds of each race/ethnicity/language group meeting statin eligibility via the National Cholesterol Education Program Adult Treatment Panel III Guidelines in 2009–2013 or the ACC/AHA guidelines in 2014–2018. (2) Among those eligible, odds of each group in each period with a statin prescription. Key Results: In 2009–2013 (n = 109,330), non-English-preferring Latino (OR = 1.10, 95% CI = 1.03, 1.17), White (OR = 1.41, 95% CI = 1.16, 1.72), and Black patients (OR = 1.25, 95% CI = 1.11, 1.42), were more likely than English-preferring non-Hispanic Whites to meet guideline criteria for statins. Non-English-preferring Black patients, when eligible, were no more likely than non-Hispanic Whites to have statin prescriptions (OR = 1.16, 95% CI = 0.88, 1.54). In 2014–2018 (n = 319,904), English-preferring Latino patients (OR = 1.02, 95% CI = 0.96–1.07) and non-English-preferring Black patients (OR = 1.08, 95% CI = 0.98, 1.19) had similar odds of statin prescription to English-preferring non-Hispanic White patients. English-preferring Black patients were less likely (OR = 0.95, 95% CI = 0.91–0.99) to have a prescription than English-preferring non-Hispanic Whites. Conclusion: Across the 2013 ACC/AHA guideline change in CHCs serving low-income patients, non-English-preferring patients were consistently more likely to be eligible for and have been prescribed statins. English-preferring Latino and English-preferring Black patients experienced reduced prescribing, comparatively, after the guideline change. Further work should explore the contextual factors that may influence guideline effectiveness and care equity.
AB - Background: It is uncertain if the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines for the use of HMGCoA reductase inhibitors (statins) were associated with increased statin eligibility and prescribing across underserved groups. Objective: To analyze, by race, ethnicity, and preferred language, patients with indications for and presence of a statin prescription before and after the guideline change. Design: Retrospective cohort study. Setting: Multistate community health center (CHC) network with linked electronic health records. Patients: Low-income patients aged ≥ 50 with a primary care visit in 2009–2013 or 2014–2018. Main Measures: (1) Odds of each race/ethnicity/language group meeting statin eligibility via the National Cholesterol Education Program Adult Treatment Panel III Guidelines in 2009–2013 or the ACC/AHA guidelines in 2014–2018. (2) Among those eligible, odds of each group in each period with a statin prescription. Key Results: In 2009–2013 (n = 109,330), non-English-preferring Latino (OR = 1.10, 95% CI = 1.03, 1.17), White (OR = 1.41, 95% CI = 1.16, 1.72), and Black patients (OR = 1.25, 95% CI = 1.11, 1.42), were more likely than English-preferring non-Hispanic Whites to meet guideline criteria for statins. Non-English-preferring Black patients, when eligible, were no more likely than non-Hispanic Whites to have statin prescriptions (OR = 1.16, 95% CI = 0.88, 1.54). In 2014–2018 (n = 319,904), English-preferring Latino patients (OR = 1.02, 95% CI = 0.96–1.07) and non-English-preferring Black patients (OR = 1.08, 95% CI = 0.98, 1.19) had similar odds of statin prescription to English-preferring non-Hispanic White patients. English-preferring Black patients were less likely (OR = 0.95, 95% CI = 0.91–0.99) to have a prescription than English-preferring non-Hispanic Whites. Conclusion: Across the 2013 ACC/AHA guideline change in CHCs serving low-income patients, non-English-preferring patients were consistently more likely to be eligible for and have been prescribed statins. English-preferring Latino and English-preferring Black patients experienced reduced prescribing, comparatively, after the guideline change. Further work should explore the contextual factors that may influence guideline effectiveness and care equity.
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U2 - 10.1007/s11606-023-08139-x
DO - 10.1007/s11606-023-08139-x
M3 - Article
C2 - 36977971
AN - SCOPUS:85151249515
SN - 0884-8734
VL - 38
SP - 2970
EP - 2979
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 13
ER -