Frank, David A.
(2023)
Disparities in Guideline-Recommended Statin Use for Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and Sex: A Nationally Representative Cross-Sectional Analysis of Adults in the United States.
Master Essay, University of Pittsburgh.
Abstract
Background: Although statins are a Class I recommendation for prevention of atherosclerotic cardiovascular disease (ASCVD) among patients with elevated risk, their use is suboptimal. Differential underuse of statins may mediate disparities in cardiovascular health for minoritized individuals. The objective of this study is to estimate disparities in statin use by race-ethnicity and sex.
Methods: We performed a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) from 2015 – 2020. We identified individuals ages 21 – 75 eligible 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 exposure of interest was race-ethnicity and sex combined (e.g., Non-Hispanic Black females; Non-Hispanic Black males). The main outcome of interest was use of a statin. Using the Institute of Medicine framework for unequal treatment, we developed logistic regression models to estimate race-ethnicity-sex disparities in statin use adjusting for age, disease severity, access to healthcare, and socioeconomic status.
Results: Among 13,213 NHANES participants ages 21 – 75, we identified 5,898 eligible for a statin, representing 78.8 million individuals in the U.S. population. After adjustment for all covariates, including access and socioeconomic factors, non-Hispanic Black males (aOR 0.55, 95% CI 0.36 – 0.85), non-Mexican Hispanic females (aOR 0.52, 95% CI 0.29 – 0.93), and non-Hispanic Black females (aOR 0.69, 95% CI 0.50 – 0.95) had significantly lower odds of statin use relative to non-Hispanic White males.
Conclusion: This study demonstrates statin-use disparities affecting non-Hispanic Black males, non-Mexican Hispanic females, and non-Hispanic Black females that are not explained by medical appropriateness of therapy or observable disparities in socioeconomic status or access to care. The public health significance of this study is in its identification of disparities and in statin use by race, ethnicity, and sex in a nationally-representative sample. Further research should be done to investigate the unobserved factors contributing to these residual disparities which may include bias, stereotyping, and mistrust.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
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| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Chair | Glynn, Nancy W. | epidnwg@pitt.edu | epidnwg | UNSPECIFIED | | Committee Member | Vajravelu, Ravy K. | ravy.vajravelu@pitt.edu | ravy.vajravelu | UNSPECIFIED | | Committee Member | Hausmann, Leslie RM | leslieh@pitt.edu | leslieh | UNSPECIFIED |
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| Date: |
17 May 2023 |
| Date Type: |
Completion |
| Submission Date: |
19 April 2023 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
52 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Race ethnicity sex statin NHANES disparities |
| Date Deposited: |
17 May 2023 17:29 |
| Last Modified: |
17 May 2023 17:29 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/44632 |
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