Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Biostatistics Group, School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA.
J Gen Intern Med. 2024 Aug;39(11):2041-2050. doi: 10.1007/s11606-024-08822-7. Epub 2024 Jun 10.
Studies assessing equity in the prevention of atherosclerotic cardiovascular disease (ASCVD) for Latinos living in the USA collectively yield mixed results. Latino persons are diverse in many ways that may influence cardiovascular health. The intersection of Latino nativity and ASCVD prevention is understudied.
To determine whether disparities in ASCVD screening, detection, and prescribing differ for US Latinos by country of birth.
A retrospective cohort design utilizing 2014-2020 electronic health record data from a network of 320 community health centers across 12 states. Analyses occurred October 1, 2022, to September 30, 2023.
Non-Hispanic White and Latino adults age 20-75 years, born in Cuba, Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, and the USA.
Ethnicity and country of birth.
Outcome measures included prevalence of statin eligibility, of having insufficient data to establish eligibility, odds of having a documented statin prescription, and rates of statin prescriptions and refills. We used covariate-adjusted logistic and generalized estimating equations logistic and negative binomial regressions to generate absolute and relative measures.
Among 108,672 adults, 23% (n = 25,422) were statin eligible for primary or secondary prevention of ASCVD using American College of Cardiology/American Heart Association guidelines. Latinos, born in and outside the USA were more likely eligible than Non-Hispanic White patients were (US-born Latino OR = 1.55 (95% CI = 1.37-1.75); non-US-born Latino OR = 1.63 (95% CI = 1.34-1.98)). The eligibility criteria that was met differed by ethnicity and nativity. Latinos overall were less likely missing data to establish eligibility and differences were again observed by specific non-US country of origin. Among those eligible, we observed no statistical difference in statin prescribing between US-born Latinos and non-Hispanic White persons; however, disparities varied by specific non-US country of origin.
Efforts to improve Latino health in the USA will require approaches for preventing and reversing cardiovascular risk factors, and statin initiation that are Latino subgroup specific.
评估居住在美国的拉丁裔人群预防动脉粥样硬化性心血管疾病（ASCVD）公平性的研究结果参差不齐。拉丁裔人群在许多方面存在差异，这些差异可能会影响心血管健康。拉丁裔的出生地与 ASCVD 预防之间的交集研究不足。
确定不同出生地的美国拉丁裔人群在 ASCVD 筛查、检测和处方方面是否存在差异。
这是一项回顾性队列设计，利用 2014 年至 2020 年来自 12 个州的 320 个社区卫生中心网络的电子健康记录数据进行分析。分析于 2022 年 10 月 1 日至 2023 年 9 月 30 日进行。
年龄在 20-75 岁之间的非西班牙裔白人和拉丁裔成年人，出生于古巴、多米尼加共和国、萨尔瓦多、危地马拉、洪都拉斯、墨西哥和美国。
种族和出生地。
结果指标包括他汀类药物适用的患病率、缺乏数据确定适用的患病率、有记录的他汀类药物处方的可能性以及他汀类药物处方和续方的比率。我们使用协变量调整后的逻辑和广义估计方程逻辑和负二项回归来生成绝对和相对指标。
在 108672 名成年人中，根据美国心脏病学会/美国心脏协会指南，23%（n=25422）的成年人符合他汀类药物一级或二级预防 ASCVD 的标准。与非西班牙裔白人患者相比，出生于美国和美国境外的拉丁裔患者更符合适用标准（美国出生的拉丁裔 OR=1.55（95%CI=1.37-1.75）；非美国出生的拉丁裔 OR=1.63（95%CI=1.34-1.98））。符合条件的标准因种族和出生地而异。总体而言，拉丁裔患者缺乏确定适用条件的数据较少，而且这种差异也因特定的非美国原籍国而异。在符合条件的患者中，我们观察到美国出生的拉丁裔患者与非西班牙裔白人患者之间在他汀类药物处方方面没有统计学差异；然而，差异因特定的非美国原籍国而异。
要改善美国拉丁裔人群的健康状况，需要采取针对特定拉丁裔亚群的预防和逆转心血管风险因素以及启动他汀类药物的方法。
