Introduction: Statins reduce the incidence of major cardiovascular disease events, but many individuals do not receive them. The AHRQ National Healthcare Disparities Report identifies several vulnerable populations, but few studies have examined statin use from the perspective of the presence of multiple vulnerabilities in the same individual.
Hypothesis: A greater number of vulnerabilities is associated with lower statin use.
Methods: This study used data from the REGARDS study, which included 30,239 adults of age 45 and older recruited between 2003 and 2007 from the 48 contiguous US states. Baseline data included a 45-minute telephone interview and an in-home visit. Vulnerabilities included older age, black race, being a woman, rural/small city residence, area level poverty, Southeastern residence, and lack of health insurance. Prevalence ratios were estimated from Poisson models and adjusted for factors influencing health services utilization (education, awareness of hyperlipidemia, medication adherence, cigarette smoking, depressive symptoms, obesity, high-density lipoprotein cholesterol, physical functioning and Adult Treatment Panel III Framingham Risk Group).
Results: The study sample included 18,047 individuals of mean age 65.8 years with indications for statin therapy; 41.7% were black, 50.8% were women, 8.7% lived in a rural area/small city, 25.2% lived in areas with >25% of residents living below the Federal poverty line, 55.0% lived in the Southeastern states and 6% did not have health insurance. Older age, being black, being a woman, area level poverty, and health insurance were significantly associated with lower statin use. Statin use decreased as the number of vulnerabilities increased.
Conclusions: A greater burden of healthcare disparity vulnerabilities was associated with a graded pattern of lower statin use. Individuals with multiple vulnerabilities have the greatest risk of under treatment and should be targeted for intervention.