他汀类药物依从性方面的种族和族裔差异：来自“我们所有人”研究项目的见解。
Racial and Ethnic Disparities in Statin Adherence: Insights from the All of Us Research Program.
作者信息
Escobar Gabriela, Azizi Zahra, de Hond Anne, Lewis Ashley Adanna, Ng Madelena Y, Rodriguez Fatima, Hernandez-Boussard Tina
机构信息
Stanford University, Stanford, CA, USA.
Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
出版信息
medRxiv. 2025 Aug 28:2025.08.26.25334490. doi: 10.1101/2025.08.26.25334490.
BACKGROUND
Statin adherence impacts cardiovascular outcomes, yet disparities persist. Understanding sociodemographic factors and barriers is crucial for targeted interventions.
OBJECTIVE
To investigate the relationship between sociodemographic factors and statin adherence across racial and ethnic groups.
DESIGN
This retrospective study examined sociodemographic factors, prescription records, clinical factors, and responses from the Demographic, Drug Exposure, Healthcare Utilization Survey (HUS) in the All of Us (AoU) cohort. Multivariable logistic regression models assessed the impact of sociodemographic factors on adherence stratified by race.
PARTICIPANTS
Adult participants with statin prescription records. Subgroup analyses included those who responded to the HUS.
EXPOSURES
Statin prescription.
MAIN OUTCOMES AND MEASURES
Percent days covered (PDC), calculated as the proportion of days within a year in which a person prescribed a statin filled a prescription. Adequate adherence was defined as PDC ≥ 80%.
RESULTS
Of the 17,029 participants with a statin prescription, the mean statin PDC was 57%, with 66% reporting a PDC ≤ 80%. Racial and ethnic differences in adherence were observed, with Non-Hispanic White (NHW) participants having a median PDC of 74% (IQR [0.25,0.98]), Non-Hispanic Black (NHB) 49% (IQR [0.25,0.98]), and Hispanic participants 25% (IQR [0.08,0.49]). NHW participants faced employment barriers (OR 0.63, 95% CI [0.46, 0.86]) and provider inaccessibility (OR 0.56, 95% CI [0.40, 0.76]) as significant factors for lower adherence. NHB participants experienced patient anxiety (OR 0.53, 95% CI [0.30, 0.90]) and financial barriers (OR 0.65, 95% CI [0.50, 0.85]), while Hispanic participants showed patient anxiety (OR 0.14, 95% CI [0.02, 0.60]) and immigrant status (OR 0.36, 95% CI [0.17, 0.76]) as significant factors for lower adherence.
CONCLUSIONS AND RELEVANCE
To address cardiovascular disease disparities, it is crucial to recognize unique sociodemographic barriers to statin adherence within racial and ethnic groups. Our findings highlight the need for tailored strategies considering the diverse barriers each group faces. Targeted interventions can bridge adherence gaps and improve cardiovascular outcomes across populations. This approach recognizes that while race and ethnicity may correlate with specific barriers, it is the underlying SDoH that often play a pivotal role in statin adherence.
背景
他汀类药物的依从性会影响心血管疾病的治疗效果，但差异仍然存在。了解社会人口学因素和障碍对于有针对性的干预措施至关重要。
目的
研究不同种族和族裔群体中社会人口学因素与他汀类药物依从性之间的关系。
设计
这项回顾性研究考察了社会人口学因素、处方记录、临床因素以及来自“我们所有人”（AoU）队列中的人口统计学、药物暴露、医疗保健利用调查（HUS）的回复。多变量逻辑回归模型评估了社会人口学因素对按种族分层的依从性的影响。
参与者
有他汀类药物处方记录的成年参与者。亚组分析包括那些回复了HUS的参与者。
暴露因素
他汀类药物处方。
主要结局和测量指标
覆盖天数百分比（PDC），计算方法为一年内开具他汀类药物处方的人实际取药的天数比例。充分依从性定义为PDC≥80%。
结果
在17029名有他汀类药物处方的参与者中，他汀类药物的平均PDC为57%，66%的参与者报告PDC≤80%。观察到依从性存在种族和族裔差异，非西班牙裔白人（NHW）参与者的PDC中位数为74%（四分位间距[0.25,0.98]），非西班牙裔黑人（NHB）为49%（四分位间距[0.25,0.98]），西班牙裔参与者为25%（四分位间距[0.08,0.49]）。NHW参与者面临就业障碍（比值比0.63，95%置信区间[0.46,0.86]）和难以就医（比值比0.56，95%置信区间[0.40,0.76]），这些是依从性较低的重要因素。NHB参与者经历患者焦虑（比值比0.53，95%置信区间[0.30,0.90]）和经济障碍（比值比0.65，95%置信区间[0.50,0.85]），而西班牙裔参与者表现出患者焦虑（比值比0.14，95%置信区间[0.02,0.60]）和移民身份（比值比0.36，95%置信区间[0.17,0.76]）是依从性较低的重要因素。
结论及意义
为解决心血管疾病差异问题，认识到种族和族裔群体中他汀类药物依从性存在的独特社会人口学障碍至关重要。我们的研究结果强调了需要考虑每个群体面临的各种障碍的定制策略。有针对性的干预措施可以弥合依从性差距并改善整个人群的心血管疾病治疗效果。这种方法认识到虽然种族和族裔可能与特定障碍相关，但往往是潜在的社会决定健康因素在他汀类药物依从性中起关键作用。
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