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Racial differences in statin adherence following hospital discharge for ischemic stroke
Karen C Albright1, Hong Zhao2, Justin Blackburn2
1From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham. kca@uab.edu.
Objective:
To compare nonadherence to statins in older black and white adults following an ischemic stroke.
Methods:
We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately.
Results:
Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01-1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02-1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01-1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10-1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01-1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08-5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01-1.78) were associated with nonadherence.
Conclusions:
Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.