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初级保健环境中他汀类药物处方的差异:一项回顾性观察研究。

Disparities in the Prescription of Statins in the Primary Care Setting: A Retrospective Observational Study.

机构信息

Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

出版信息

Curr Probl Cardiol. 2022 Nov;47(11):101329. doi: 10.1016/j.cpcardiol.2022.101329. Epub 2022 Jul 20.

Abstract

Despite the high disease burden of atherosclerosis, evidence exists for the disparity in the prescription of guideline-indicated medications between genders, racial groups, socioeconomic groups, and ages. We aim to perform a retrospective study looking at the disparity in statin prescription for primary and secondary prevention in these groups. Data were collected from a single center and included patients with an LDL level >190 mg/dL, diagnosis of diabetes mellitus with LDL level >70 mg/dL, and diagnosis of cardiovascular disease regardless of LDL level. Patients older than 75 or younger than 21 were excluded from the study. Complex samples multivariable logistic and linear regression models were used to calculate the adjusted odds ratio and 95% confidence interval. The total study population was n = 56,995. Of those, 57.89% (n = 32,992) were female. Only 59.56 % of these patients for whom statin therapy was indicated received it. Most patients were White (53.21%) followed by African Americans (35.98%), Asians (2.43%), American Indian/Native Alaskans (0.40%), and Native Hawaiian/Pacific Islander (0.18%). There is a clear disparity in statin prescription favoring males, the elderly, and people of white ethnicity. Interestingly, Asians were more likely to be prescribed statins as opposed to whites. Self-pay patients were more likely to receive statins than patients on Medicare.Despite being indicated, Statins are under prescribed. Disparities based on race, gender, and insurance type mirror previous trends in the literature. Some results have shown a reversal in trends such as the higher prescription for Asian-Americans. Multiple patient-specific, provider-related, institutional factors might explain these disparities and must be investigated.

摘要

尽管动脉粥样硬化疾病负担很高,但在性别、种族、社会经济群体和年龄方面,指南推荐的药物的处方存在差异。我们旨在进行一项回顾性研究,观察这些群体中他汀类药物在一级和二级预防中的处方差异。数据来自一个单一的中心,包括 LDL 水平> 190 mg/dL 的患者、诊断为糖尿病且 LDL 水平> 70 mg/dL 的患者以及无论 LDL 水平如何诊断为心血管疾病的患者。排除年龄大于 75 岁或小于 21 岁的患者。使用复杂样本多变量逻辑和线性回归模型计算调整后的优势比和 95%置信区间。总研究人群为 n=56995。其中,57.89%(n=32992)为女性。只有 59.56%的符合他汀类药物治疗指征的患者接受了治疗。大多数患者为白人(53.21%),其次为非裔美国人(35.98%)、亚洲人(2.43%)、美洲印第安人/阿拉斯加原住民(0.40%)和夏威夷原住民/太平洋岛民(0.18%)。他汀类药物的处方明显存在性别、年龄和种族差异,有利于男性、老年人和白种人。有趣的是,与白人相比,亚洲人更有可能被开出处方。自付费患者比医疗保险患者更有可能接受他汀类药物治疗。尽管有指征,但他汀类药物的使用不足。基于种族、性别和保险类型的差异反映了文献中的先前趋势。一些结果显示,亚裔美国人的处方率更高,这种趋势有所逆转。可能有多个患者特定、提供者相关、机构因素可以解释这些差异,必须进行调查。

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