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Gender Differences in Statin Discontinuation and Adherence Among Privately Insured People with HIV in the USA
Thibaut Davy-Mendez1,2, Alan C Kinlaw3,4, Shelby Tungate Lopez5
1Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. tdavy@med.unc.edu.
Insights
People with HIV (PWH) often discontinue statin therapy, with women experiencing higher rates of discontinuation and low adherence compared to men. Addressing these barriers is crucial for preventing cardiovascular disease (CVD) in PWH, especially women.
Area of Science:
- Cardiovascular Medicine
- Infectious Disease Epidemiology
- Pharmacoepidemiology
Background:
- People with HIV (PWH) face a higher burden of cardiovascular disease (CVD) than the general population, particularly women.
- Limited data exists on statin adherence among PWH, hindering efforts to reduce CVD disparities.
Purpose of the Study:
- To examine statin discontinuation and adherence rates in privately insured PWH under age 65.
- To compare statin adherence between women and men with HIV.
Main Methods:
- An observational cohort study using MarketScan data from 2015-2022.
- Analysis of outpatient pharmacy claims to assess statin discontinuation (gap >90 days) and proportion of days covered (PDC).
- Cox models and log-binomial regression were used to compare discontinuation and adherence between women and men, adjusting for confounders.
Main Results:
- The study included 9522 PWH initiating statin therapy; 50.0% experienced discontinuation within 2 years.
- Overall, 26.5% of PWH had low statin adherence (PDC <80%) during therapy.
- Women with HIV were more likely to discontinue statins (59.0% vs. 48.1%) and had lower adherence (34.1% vs. 25.2%) compared to men within 2 years.
Conclusions:
- High rates of statin discontinuation and low adherence were observed in PWH.
- Women with HIV exhibited significantly higher statin discontinuation and lower adherence rates than men.
- Targeted interventions are necessary to overcome statin adherence barriers and mitigate CVD risk in PWH, with a focus on women.
Background:
People with HIV (PWH), particularly women, have a high cardiovascular disease (CVD) burden compared to the general population. There is little evidence describing statin adherence among PWH, which could inform interventions to reduce CVD disparities.
Objective:
Observational cohort of privately insured PWH under age 65 who initiated statin therapy during 2015-2022 in MarketScan data.
Main Measures:
We used outpatient pharmacy claims to examine (1) statin discontinuation, defined as a gap > 90 days, and (2) proportion of days covered (PDC) by a statin in 90-day intervals. We estimated hazard ratios (HRs) using Cox models to compare discontinuation rates and prevalence ratios (PRs) from log-binomial regression to compare the probability of having low adherence (PDC < 80%) between women and men. We adjusted for potential confounding by demographic and clinical factors and accounted for repeated PDC measures.
Key Results:
We included 9522 PWH who initiated a statin (median age 52 years, 17.3% women). Overall, 50.0% of PWH had statin discontinuation within 2 years, and 26.5% had low adherence during statin therapy. Within 2 years, 59.0% of women and 48.1% of men had experienced discontinuation (adjusted HR 1.30 (95% CI, 1.20-1.41)). Among PWH remaining on statins, low adherence (PDC < 80%) was more common among women (34.1%) than men (25.2%) (adjusted PR 1.29 (1.22-1.35)).
Conclusions:
PWH had high statin discontinuation rates, and a quarter had low adherence. Compared to men, women were both more likely to discontinue and have lower adherence. Efforts are needed to address statin adherence barriers to prevent CVD in PWH, especially in women with HIV.
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