Age and sex disparities in discharge statin prescribing in the stroke belt: Evidence from the reasons for geographic and racial differences in stroke study

Karen C. Albright, Virginia J. Howard, George Howard, Paul Muntner, Vera Bittner, Monika M. Safford, Amelia K. Boehme, J. David Rhodes, T. Mark Beasley, Suzanne E. Judd, Leslie A. McClure, Nita Limdi, Justin Blackburn

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background--Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing. Methods and Results--We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7% were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47% less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95% CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95% CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95% CI, 0.69-1.26; P for interaction=0.228). Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR, 0.69; 95% CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95% CI, 0.99-1.92; P for interaction=0.004). Conclusions--Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.

Original languageEnglish (US)
Article numbere005523
JournalJournal of the American Heart Association
Volume6
Issue number8
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stroke
Atrial Fibrillation
Medical Records

Keywords

  • Disparities
  • Prescribing patterns
  • Secondary prevention
  • Statins
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Age and sex disparities in discharge statin prescribing in the stroke belt : Evidence from the reasons for geographic and racial differences in stroke study. / Albright, Karen C.; Howard, Virginia J.; Howard, George; Muntner, Paul; Bittner, Vera; Safford, Monika M.; Boehme, Amelia K.; Rhodes, J. David; Beasley, T. Mark; Judd, Suzanne E.; McClure, Leslie A.; Limdi, Nita; Blackburn, Justin.

In: Journal of the American Heart Association, Vol. 6, No. 8, e005523, 01.08.2017.

Research output: Contribution to journalArticle

Albright, KC, Howard, VJ, Howard, G, Muntner, P, Bittner, V, Safford, MM, Boehme, AK, Rhodes, JD, Beasley, TM, Judd, SE, McClure, LA, Limdi, N & Blackburn, J 2017, 'Age and sex disparities in discharge statin prescribing in the stroke belt: Evidence from the reasons for geographic and racial differences in stroke study', Journal of the American Heart Association, vol. 6, no. 8, e005523. https://doi.org/10.1161/JAHA.117.005523
Albright, Karen C. ; Howard, Virginia J. ; Howard, George ; Muntner, Paul ; Bittner, Vera ; Safford, Monika M. ; Boehme, Amelia K. ; Rhodes, J. David ; Beasley, T. Mark ; Judd, Suzanne E. ; McClure, Leslie A. ; Limdi, Nita ; Blackburn, Justin. / Age and sex disparities in discharge statin prescribing in the stroke belt : Evidence from the reasons for geographic and racial differences in stroke study. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 8.
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abstract = "Background--Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing. Methods and Results--We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7{\%} were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47{\%} less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95{\%} CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95{\%} CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95{\%} CI, 0.69-1.26; P for interaction=0.228). Compared with women, men in the Stroke Belt were 31{\%} less likely to be discharged on a statin (RR, 0.69; 95{\%} CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95{\%} CI, 0.99-1.92; P for interaction=0.004). Conclusions--Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.",
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T1 - Age and sex disparities in discharge statin prescribing in the stroke belt

T2 - Evidence from the reasons for geographic and racial differences in stroke study

AU - Albright, Karen C.

AU - Howard, Virginia J.

AU - Howard, George

AU - Muntner, Paul

AU - Bittner, Vera

AU - Safford, Monika M.

AU - Boehme, Amelia K.

AU - Rhodes, J. David

AU - Beasley, T. Mark

AU - Judd, Suzanne E.

AU - McClure, Leslie A.

AU - Limdi, Nita

AU - Blackburn, Justin

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N2 - Background--Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing. Methods and Results--We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7% were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47% less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95% CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95% CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95% CI, 0.69-1.26; P for interaction=0.228). Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR, 0.69; 95% CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95% CI, 0.99-1.92; P for interaction=0.004). Conclusions--Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.

AB - Background--Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing. Methods and Results--We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7% were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47% less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95% CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95% CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95% CI, 0.69-1.26; P for interaction=0.228). Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR, 0.69; 95% CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95% CI, 0.99-1.92; P for interaction=0.004). Conclusions--Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.

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KW - Prescribing patterns

KW - Secondary prevention

KW - Statins

KW - Stroke

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