Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA; Biostatistics Group, School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA.
Prev Med. 2022 Nov;164:107338. doi: 10.1016/j.ypmed.2022.107338. Epub 2022 Nov 9.
Atherosclerotic cardiovascular disease (ASCVD) disproportionally affects racial and ethnic minority populations. Statin prescribing guidelines changed in 2013 to improve ASCVD prevention. It is unknown whether risk screening for statin eligibility differed across race and ethnicity over this guideline change. We examine racial/ethnic/language differences in screening measure prevalence for period-specific statin consideration using a retrospective cohort design and linked electronic health records from 635 community health centers in 24 U.S. states. Adults 50+ years, without known ASCVD, and ≥ 1 visit in 2009-2013 and/or 2014-2018 were included, grouped as: Asian, Latino, Black, or White further distinguished by language preference. Outcomes included screening measure prevalence for statin consideration, 2009-2013: low-density lipoprotein (LDL), 2014-2018: pooled cohort equation (PCE) components age, sex, race, systolic blood pressure, total cholesterol, high-density lipoprotein, smoking status. Among patients seen both periods, change in period-specific measure prevalence was assessed. Adjusting for sociodemographic and clinical factors, compared to English-preferring White patients, all other groups were more likely to have LDL documented (2009-2013, n = 195,061) and all PCE components documented (2014-2018, n = 344,504). Among patients seen in both periods (n = 128,621), all groups had lower odds of PCE components versus LDL documented in the measures' respective period; English-preferring Black adults experienced a greater decline compared to English-preferring White adults (OR 0.81; 95% CI: 0.72-0.91). Racial/ethnic/language disparities in documented screening measures that guide statin therapy for ASCVD prevention were unaffected by a major guideline change advising this practice. It is important to understand whether the newer guidelines have altered disparate prescribing and morbidity/mortality for this disease.
动脉粥样硬化性心血管疾病（ASCVD）在不同种族和族裔人群中的发病率不成比例。2013 年，他汀类药物的处方指南发生了变化，以改善 ASCVD 的预防效果。目前尚不清楚在指南修改后，不同种族和族裔是否会在他汀类药物适应证的风险筛查方面存在差异。我们使用回顾性队列设计和来自美国 24 个州的 635 家社区医疗中心的电子健康记录，研究了特定他汀类药物考虑的筛查措施在种族/族裔/语言方面的差异。研究对象为 50 岁以上、无已知 ASCVD 且在 2009-2013 年和/或 2014-2018 年至少有 1 次就诊记录的成年人，分为亚裔、拉丁裔、非裔和白人，他们进一步根据语言偏好进行了区分。结果包括他汀类药物考虑的筛查措施的流行率，2009-2013 年为低密度脂蛋白（LDL），2014-2018 年为汇总队列方程（PCE）的年龄、性别、种族、收缩压、总胆固醇、高密度脂蛋白、吸烟状况。在观察了两个时期的患者中，评估了特定时期的措施流行率的变化。在调整了社会人口统计学和临床因素后，与英语偏好的白人患者相比，所有其他群体更有可能记录 LDL（2009-2013 年，n=195061）和所有 PCE 成分（2014-2018 年，n=344504）。在观察了两个时期的患者中（n=128621），与各自时期的 LDL 相比，所有群体记录的 PCE 成分的可能性均较低；与英语偏好的白人成年人相比，英语偏好的黑人成年人经历了更大的下降（OR 0.81；95%CI：0.72-0.91）。在指导 ASCVD 预防他汀类药物治疗的有记录的筛查措施方面，种族/族裔/语言方面的差异不受建议这一做法的主要指南变化的影响。了解新指南是否改变了这种疾病的不同处方和发病率/死亡率非常重要。
