Statin Eligibility and Prescribing Across Racial, Ethnic, and Language Groups over the 2013 ACC/AHA Guideline Change: a Retrospective Cohort Analysis from 2009 to 2018

John Heintzman, Jorge Kaufmann, Carlos J. Rodriguez, Jennifer A. Lucas, Dave Boston, Ayana K. April-Sanders, Katherine Chung-Bridges, Miguel Marino

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1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2970-2979
Number of pages10
JournalJournal of general internal medicine
Volume38
Issue number13
DOIs
StatePublished - Oct 2023

ASJC Scopus subject areas

  • Internal Medicine

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