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Disparities in Guideline Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease
Jamuna K Krishnan1, Sonal G Mallya2,3, Musarrat Nahid3
1Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States.
Insights
Black women and White women with chronic obstructive pulmonary disease (COPD) are less likely to receive statin treatment for cardiovascular disease (CVD) prevention compared to White men. This disparity persists even after accounting for healthcare utilization factors.
Area of Science:
- Cardiology
- Pulmonology
- Health Disparities
Background:
- Cardiovascular disease (CVD) significantly impacts prognosis for patients with chronic obstructive pulmonary disease (COPD).
- Black women with COPD face a disproportionately higher risk of CVD-related mortality.
- Existing disparities in CVD prevention strategies for COPD patients are not well understood.
Purpose of the Study:
- To investigate race- and sex-based differences in statin prescription for CVD prevention among COPD patients.
- To determine if healthcare utilization factors explain these observed racial and sex disparities.
Main Methods:
- Cross-sectional analysis of Medicare beneficiaries with COPD from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
- Statin use was assessed via in-home pill bottle review for individuals with a documented statin indication.
- Poisson regression with robust variance was used to estimate prevalence ratios (PR) for statin treatment across race-sex groups compared to White men, adjusting for healthcare utilization covariates.
Main Results:
- Among 1435 participants with a statin indication, all race-sex groups received statins less frequently than White men.
- Black women (PR 0.76) and White women (PR 0.84) remained significantly less likely to receive statin treatment compared to White men after adjustment.
- These disparities in statin use were observed despite controlling for factors influencing healthcare utilization.
Conclusions:
- Significant disparities exist in statin treatment for CVD prevention among individuals with COPD.
- Women, particularly Black women, are less likely to receive guideline-indicated statin therapy compared to White men.
- Addressing these disparities requires structural interventions beyond individual healthcare utilization factors.
Rationale:
Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown.
Objectives:
We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort.
Methods:
We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact health care utilization.
Results:
Of the 2032 members within the COPD sub-cohort with sufficient data, 1435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence health care utilization, Black women (PR 0.76, 95% confidence interval [CI] 0.67 to 0.86) and White women (PR 0.84 95% CI 0.76 to 0.91) remained less likely to be treated compared to White men.
Conclusions:
All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual health care utilization factors, suggesting structural interventions are needed.
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