Introduction: The current USPSTF guidelines recommend use of aspirin for primary prevention of CAD in adults aged between 50-69 years. In our study, we sought to determine the association of household income and socioeconomic factors and the use of aspirin for the primary prevention of CAD in the eligible population.
Methods: After excluding the participants with prior diagnosis of CAD, those who had a condition which would make the use of aspirin unsafe and missing data on household income, we analyzed a total of 3,913 participants from the Behavioral Risk Factor Surveillance System 2015 database for our study. We performed univariate comparison of various covariates in two categories of participants based on an income threshold of 50,000$. Subsequently, we performed logistic regression and stepwise modeling approach for multivariable analyses to assess the association between the use of aspirin (outcome) and various covariates.
Results: In an unadjusted logistic regression model, the participants with household income < $15,000 were 67% less likely to use aspirin (OR: 0.33, 95% CI: 0.23-0.47, p< 0.0001) in comparison with the reference group of > $50,000 household income. After adjusting for race, education, insurance, gender, household size and cholesterol awareness in our fully adjusted model, we observed that the participants with household income of $35,000 to $50,000 were 53% less likely to take aspirin for prevention of CAD as compared to referent group of income > 50,000$ (adjusted OR: 0.47, 95% CI: 0.28-0.76, p = 0.003). The participants of Hispanic race were also about 43% less likely to take aspirin as compared to Caucasians (adjusted OR: 0.57, 95% CI: 0.40-0.80, p = 0.002).
Conclusions: Our findings highlight significant disparities in the use of aspirin for primary prevention of CAD potentially reflecting the role of income and racial factors. A targeted approach to address the use of aspirin in these subgroups might be beneficial.