Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (D.A.F.).
Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (A.E.J.).
Ann Intern Med. 2023 Aug;176(8):1057-1066. doi: 10.7326/M23-0720. Epub 2023 Jul 25.
Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons.
To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors.
Cross-sectional analysis.
National Health and Nutrition Examination Survey from 2015 to 2020.
Persons eligible for statin therapy based on 2013 and 2018 American College of Cardiology/American Heart Association blood cholesterol guidelines.
The independent variable was race-ethnicity-gender. The outcome of interest was use of a statin. Using the Institute of Medicine framework for examining unequal treatment, we calculated adjusted prevalence ratios (aPRs) to estimate disparities in statin use adjusted for age, disease severity, access to health care, and socioeconomic status relative to non-Hispanic White men.
For primary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors among non-Hispanic Black men (aPR, 0.73 [95% CI, 0.59 to 0.88]) and non-Mexican Hispanic women (aPR, 0.74 [CI, 0.53 to 0.95]). For secondary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors for non-Hispanic Black men (aPR, 0.81 [CI, 0.64 to 0.97]), other/multiracial men (aPR, 0.58 [CI, 0.20 to 0.97]), Mexican American women (aPR, 0.36 [CI, 0.10 to 0.61]), non-Mexican Hispanic women (aPR, 0.57 [CI, 0.33 to 0.82), non-Hispanic White women (aPR, 0.69 [CI, 0.56 to 0.83]), and non-Hispanic Black women (aPR, 0.75 [CI, 0.57 to 0.92]).
Cross-sectional data; lack of geographic, language, or statin-dose data.
Statin use disparities for several race-ethnicity-gender groups are not explained by measurable differences in medical appropriateness of therapy, access to health care, and socioeconomic status. These residual disparities may be partially mediated by unobserved processes that contribute to health inequity, including bias, stereotyping, and mistrust.
National Institutes of Health.
尽管他汀类药物是预防动脉粥样硬化性心血管疾病及其并发症的 I 类推荐药物，但它们的使用并不理想。差异化的使用不足可能导致系统性边缘化人群在心血管健康方面存在差异。
估计种族-民族-性别差异与他汀类药物使用的差异，并确定这些潜在的差异是否可以通过治疗的医学适宜性和结构因素来解释。
横断面分析。
2015 年至 2020 年全国健康和营养调查。
根据 2013 年和 2018 年美国心脏病学会/美国心脏协会的血液胆固醇指南，有资格接受他汀类药物治疗的人。
自变量是种族-民族-性别。感兴趣的结果是使用他汀类药物。使用医学研究所检查不平等治疗的框架，我们计算了调整后的患病率比（aPR），以根据年龄、疾病严重程度、获得医疗保健和社会经济地位相对于非西班牙裔白人男性，估计他汀类药物使用的差异。
对于一级预防，我们发现非西班牙裔黑人男性（aPR，0.73[95%CI，0.59 至 0.88]）和非墨西哥裔西班牙裔女性（aPR，0.74[CI，0.53 至 0.95]）中，他汀类药物使用的流行率较低，且与可衡量的疾病严重程度或结构因素无关。对于二级预防，我们发现非西班牙裔黑人男性（aPR，0.81[CI，0.64 至 0.97]）、其他/多种族男性（aPR，0.58[CI，0.20 至 0.97]）、墨西哥裔美国女性（aPR，0.36[CI，0.10 至 0.61]）、非墨西哥裔西班牙裔女性（aPR，0.57[CI，0.33 至 0.82））、非西班牙裔白人女性（aPR，0.69[CI，0.56 至 0.83））和非西班牙裔黑人女性（aPR，0.75[CI，0.57 至 0.92））中，他汀类药物使用的流行率较低，且与可衡量的疾病严重程度或结构因素无关。
横断面数据；缺乏地理、语言或他汀类药物剂量数据。
几个种族-民族-性别群体的他汀类药物使用差异不能通过治疗的医学适宜性、获得医疗保健的机会和社会经济地位的可衡量差异来解释。这些剩余的差异可能部分是由导致健康不平等的未观察到的过程介导的，包括偏见、刻板印象和不信任。
美国国立卫生研究院。
