Albright Karen C, Howard Virginia J, Howard George, Muntner Paul, Bittner Vera, Safford Monika M, Boehme Amelia K, Rhodes J David, Beasley T Mark, Judd Suzanne E, McClure Leslie A, Limdi Nita, Blackburn Justin
Geriatric Research, Education and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, AL
Department of Epidemiology, University of Alabama at Birmingham, AL.
J Am Heart Assoc. 2017 Aug 2;6(8):e005523. doi: 10.1161/JAHA.117.005523.
Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing.
We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7% were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47% less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95% CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95% CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95% CI, 0.69-1.26; for interaction=0.228). Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR, 0.69; 95% CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95% CI, 0.99-1.92; for interaction=0.004).
Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.
中风是一种代价高昂且使人衰弱的疾病，对黑人的影响尤为严重。尽管他汀类药物疗效显著，但有证据表明在他汀类药物的处方开具方面可能存在种族差异。
我们在REGARDS（中风地理和种族差异原因）研究的随访期间，分析了因缺血性中风住院的参与者的出院用药情况。入院和出院时的用药信息从医疗记录中提取。在666例符合条件的新发中风病例（2003 - 2013年）中，分析仅限于323名入院时未使用他汀类药物且无房颤病史的参与者。总体而言，48.7%的参与者出院时被开具了他汀类药物。在中风带，65岁及以上的参与者出院时使用他汀类药物的可能性比65岁以下的参与者低47%（相对风险[RR]，0.53；95%置信区间[CI]，0.38 - 0.74）。在非中风带居民中未观察到这种关联。在中风带以外，黑人出院时使用他汀类药物的可能性高于白人（RR，1.42；95% CI，1.04 - 1.94），而在中风带居民中不存在黑人与白人之间的关联（RR，0.93；95% CI，0.69 - 1.26；交互作用P值 = 0.228）。与女性相比，中风带的男性出院时使用他汀类药物的可能性低31%（RR，0.69；95% CI，0.50 - 0.94），而中风带以外的男性出院时使用他汀类药物的可能性更高（RR，1.38；95% CI，0.99 - 1.92；交互作用P值 = 0.004）。
中风带和非中风带居民在他汀类药物出院处方方面可能存在差异，尤其是在美国老年人和男性中。
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