Albright Karen C, Zhao Hong, Blackburn Justin, Limdi Nita A, Beasley T Mark, Howard George, Bittner Vera, Howard Virginia J, Muntner Paul
From 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.
Neurology. 2017 May 9;88(19):1839-1848. doi: 10.1212/WNL.0000000000003910. Epub 2017 Apr 12.
To compare nonadherence to statins in older black and white adults following an ischemic stroke.
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.
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.
Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.
比较老年黑人和白人成年人缺血性卒中后他汀类药物治疗的不依从性。
我们研究了2007年至2012年期间因缺血性卒中住院且出院后30天内开具他汀类药物处方、年龄≥66岁且参加医疗保险按服务付费计划的黑人和白人成年人。不依从性定义为出院后365天内覆盖天数比例<80%。此外，我们分别评估了白人和黑人参与者中与不依从性相关的因素。
共有2763名受益人符合纳入标准（13.5%为黑人）。即使在对人口统计学、低收入补贴领取情况和基线合并症进行调整后，黑人成年人比白人成年人更易出现不依从（49.7%对41.5%）（调整后相对风险[RR]1.14，95%置信区间[CI]1.01 - 1.29）。在白人成年人中，领取低收入补贴（调整后RR 1.13，95% CI 1.02 - 1.26）、冠心病史（调整后RR 1.15，95% CI 1.01 - 1.30）以及卒中住院后直接出院回家（调整后RR 1.26，95% CI 1.10 - 1.44）与更高的不依从风险相关。在黑人成年人中，查尔森合并症指数每增加1个单位（调整后RR 1.04，95% CI 1.01 - 1.09）、颈动脉疾病史（调整后RR 2.38，95% CI 1.08 - 5.25）以及索引卒中前365天内住院（调整后RR 1.34，95% CI 1.01 - 1.78）与不依从性相关。
与白人成年人相比，黑人成年人缺血性卒中住院后更易出现他汀类药物治疗不依从。
