Verma Amol A, Jimenez Marcia P, Subramanian S V, Sniderman Allan D, Razak Fahad
From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital-McGill University Health Centre, Montreal, Canada (A.D.S.); and Harvard Center for Population and Development Studies, Boston, MA (F.R.).
Circ Cardiovasc Qual Outcomes. 2017 Sep;10(9). doi: 10.1161/CIRCOUTCOMES.117.003764.
The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines expanded eligibility criteria for statins. We examined race and socioeconomic differences associated with these changes.
This was an observational study of adults between 40 and 75 years of age using data from the National Health and Nutrition Examination Surveys between 2005 and 2012. Change in eligibility for statins was assessed based on the third adult treatment panel criteria and the 2013 ACC/AHA guidelines. Differences relating to self-reported race, income, education, and insurance status were assessed in models that were adjusted for age and each of the other factors. Statin eligibility increased among all race, education, and income groups. Becoming newly eligible for statins was more likely for black people (25.8% newly eligible; adjusted odds ratio, 3.8; <0.001), people of other races (18.7%; adjusted odds ratio, 2.5; <0.001), those with no more than high-school education (17.3%; adjusted odds ratio, 1.7; =0.001), and those with no health insurance (17.6%; adjusted odds ratio, 1.5; <0.001) compared with white people (14.5%), those who completed college (13.0%), and those with health insurance (15.6%). Income differences were not significant after adjusting for age, race, and education. These differences were driven by the prevalence of elevated predicted cardiac risk and diabetes mellitus. Among the US adults who were newly eligible for statins, 12.4 million (66.3%) were nonwhite, had lower education or lower income, and 3.0 million (16.1%) had no health insurance. Race and socioeconomic differences in statin eligibility were more pronounced under the 2013 ACC/AHA guidelines than under third adult treatment panel. If treatment disparities remain unchanged, the 2013 ACC/AHA guidelines increase the number of US adults who are eligible but do not receive statins by 3.0 million nonwhites, 3.6 million with no more than high-school education, and 4.1 million in the lowest 2 income quartiles.
The 2013 ACC/AHA guidelines increase statin eligibility most among adults with nonwhite race, socioeconomic disadvantage, and no health insurance. Without improving access to healthcare, the potential gains from expanding indications for cardioprotective medications will not be realized.
2013年美国心脏病学会/美国心脏协会（ACC/AHA）指南扩大了他汀类药物的适用标准。我们研究了与这些变化相关的种族和社会经济差异。
这是一项对40至75岁成年人的观察性研究，使用了2005年至2012年国家健康与营养检查调查的数据。根据成人治疗专家组第三次标准和2013年ACC/AHA指南评估他汀类药物适用标准的变化。在对年龄和其他因素进行调整的模型中评估与自我报告的种族、收入、教育和保险状况相关的差异。所有种族、教育程度和收入群体中他汀类药物的适用率均有所增加。与白人（14.5%）、完成大学教育的人（13.0%）和有医疗保险的人（15.6%）相比，黑人（25.8%为新适用者；调整后的优势比为3.8；<0.001）、其他种族的人（18.7%；调整后的优势比为2.5；<0.001）、高中及以下学历的人（17.3%；调整后的优势比为1.7；=0.001）和没有医疗保险的人（17.6%；调整后的优势比为1.5；<0.001）更有可能成为新的他汀类药物适用者。在调整年龄、种族和教育程度后，收入差异不显著。这些差异是由预测的心脏风险升高和糖尿病的患病率驱动的。在美国新符合他汀类药物适用标准的成年人中，1240万（66.3%）是非白人，教育程度较低或收入较低，300万（16.1%）没有医疗保险。与成人治疗专家组第三次标准相比，2013年ACC/AHA指南下他汀类药物适用标准的种族和社会经济差异更为明显。如果治疗差距保持不变，2013年ACC/AHA指南将使符合他汀类药物适用标准但未接受治疗的美国成年人增加300万非白人、360万高中及以下学历的人和410万收入最低的两个四分位数人群。
2013年ACC/AHA指南使非白人种族、社会经济处于不利地位且没有医疗保险的成年人中他汀类药物的适用率增加最多。如果不改善医疗保健的可及性，扩大心脏保护药物适应症的潜在益处将无法实现。
