Disparities in Guideline Concordant Statin Treatment in Individuals with Chronic Obstructive Pulmonary Disease.
Academic Article
Overview
abstract
RATIONALE: Cardiovascular disease (CVD) affects prognosis in chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown. OBJECTIVES: We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing healthcare utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD sub-cohort. METHODS: We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact healthcare utilization. RESULTS: Of the 2,032 members within the COPD sub-cohort with sufficient data, 1,435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence healthcare utilization, Black women (PR 0.76, 95% CI 0.67-0.86) and White women (PR 0.84 95% CI 0.76-0.91) remained less likely to be treated compared to White men. CONCLUSIONS: All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual healthcare utilization factors, suggesting structural interventions are needed.
