Racial and Ethnic Disparities in Statin Adherence: Insights from the All of Us Research Program
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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 Outcome(s) and Measure(s)
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.
Key Points
Question
What are predictors and barriers to statin adherence in the All of Us cohort?
Findings
Among 17,029 statin users, 57% reported low statin adherence, which varied by racial and ethnic groups and was associated with social determinants of health (SDoH). For Non-Hispanic Whites, employment barriers and provider inaccessibility were linked to lower adherence. Non-Hispanic Blacks faced patient anxiety and financial barriers, while Hispanics’ adherence was impacted by immigrant status, healthcare coverage and patient anxiety.
Conclusions
Unique SDoH influence statin adherence among diverse populations. Tailored interventions addressing specific barriers are needed to improve adherence and reduce cardiovascular disease risk equitably and effectively.
