From the Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA (MB, CW, SA); Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles (MB); Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California at Irvine, Los Angeles, CA (CW); Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA (EA); Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA (SB); Department of Family Medicine, Kaiser Permanente, Los Angeles, CA (EOK).
J Am Board Fam Med. 2021 Jan-Feb;34(1):132-143. doi: 10.3122/jabfm.2021.01.200322.
Existing epidemiologic information shows disparities in low-dose aspirin use by race. This study investigates the frequency, pattern, and correlates of both self- and clinician-prescribed low-dose aspirin use among underserved African Americans aged 55 years and older.
This cross-sectional study conducted a comprehensive evaluation of all over-the-counter and prescribed medications used among 683 African American older adults in South Central Los Angeles, California. Correlation between use of low-dose aspirin and sociodemographic variables, health care continuity, health behaviors, and several major chronic medical conditions were examined. In addition, the use of low-dose aspirin as self prescribed versus clinician prescribed was examined. Multivariate logistic regression was performed to examine correlates of low-dose aspirin use.
Overall, 37% of participants were taking low-dose aspirin. Sixty percent of low-dose aspirin users were taking low-dose aspirin as self prescribed and 40% were taking it as prescribed by a clinician. Major aspirin-drug interactions were detected in 75% of participants who used low-dose aspirin, but no significant differences in aspirin-drug interactions were found between those who used aspirin as self prescribed and those who used it as clinician prescribed. No negative association between being diagnosed with gastrointestinal conditions and aspirin used was detected. Being diagnosed with diabetes mellitus or a heart condition was associated with higher use of aspirin. However, only 50% with high risk of cardiovascular took prescribed (38%) or self-prescribed (62%) low-dose aspirin. One third of participants aged 70 years and older with low risk of cardiovascular were using aspirin.
Among underserved African-American middle-aged and older adults, many who could potentially benefit from aspirin are not taking it; and many taking aspirin have no indication to do so and risk unnecessary side effects. Compared with non-Hispanic Whites, African Americans are more likely to be diagnosed with diabetes, hypertension, and heart conditions at earlier stages of life; as a result, the role of preventive intervention, including safe and appropriate use of low-dose aspirin among this segment of our population, is more salient. Interventional studies are needed to promote safe and effective use of low-dose aspirin among underserved African-American adults.
现有流行病学信息显示，不同种族人群使用低剂量阿司匹林的情况存在差异。本研究旨在调查加利福尼亚州洛杉矶中南部 683 名年龄在 55 岁及以上的服务不足的非裔美国人中，自我和临床医生开具的低剂量阿司匹林的使用频率、模式和相关因素。
这项横断面研究对加利福尼亚州洛杉矶中南部 683 名非裔美国老年人使用的所有非处方和处方药物进行了全面评估。检查了低剂量阿司匹林的使用与社会人口统计学变量、医疗连续性、健康行为以及几种主要慢性疾病之间的相关性。此外，还检查了低剂量阿司匹林作为自我处方与临床医生处方的使用情况。采用多变量逻辑回归检验低剂量阿司匹林使用的相关因素。
总体而言，37%的参与者正在服用低剂量阿司匹林。60%的低剂量阿司匹林使用者服用低剂量阿司匹林是自我处方，40%是临床医生处方。在使用低剂量阿司匹林的参与者中，有 75%检测到阿司匹林药物相互作用，但自我处方和临床医生处方使用者之间的阿司匹林药物相互作用无显著差异。患有胃肠道疾病与使用阿司匹林之间没有发现负相关。患有糖尿病或心脏病与更高的阿司匹林使用率相关。然而，仅有 50%心血管疾病高危人群服用了处方（38%）或自我处方（62%）的低剂量阿司匹林。三分之一年龄在 70 岁及以上、心血管疾病风险低的参与者正在使用阿司匹林。
在服务不足的非裔美国中年和老年人中，许多可能受益于阿司匹林的人并未服用；许多服用阿司匹林的人没有服用的指征，且存在不必要的副作用风险。与非西班牙裔白人相比，非洲裔美国人更有可能在生命早期被诊断出患有糖尿病、高血压和心脏病；因此，在这部分人群中，预防干预的作用（包括低剂量阿司匹林的安全和适当使用）更加突出。需要开展干预性研究，以促进服务不足的非裔美国成年人安全有效地使用低剂量阿司匹林。
