Racial differences in statin adherence following hospital discharge for ischemic stroke

Karen C. Albright, Hong Zhao, Justin Blackburn, Nita A. Limdi, T. Mark Beasley, George Howard, Vera Bittner, Virginia J. Howard, Paul Muntner

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To compare nonadherence to statins in older black and white adults following an ischemic stroke. Methods: We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately. Results: Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01-1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02-1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01-1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10-1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01-1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08-5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01-1.78) were associated with nonadherence. Conclusions: Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.

Original languageEnglish (US)
Pages (from-to)1839-1848
Number of pages10
JournalNeurology
Volume88
Issue number19
DOIs
StatePublished - May 9 2017
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stroke
Confidence Intervals
Hospitalization
Comorbidity
Fee-for-Service Plans
Carotid Artery Diseases
Insurance Coverage
Medicare
Prescriptions
Coronary Disease
Demography
hydroquinone

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Albright, K. C., Zhao, H., Blackburn, J., Limdi, N. A., Beasley, T. M., Howard, G., ... Muntner, P. (2017). Racial differences in statin adherence following hospital discharge for ischemic stroke. Neurology, 88(19), 1839-1848. https://doi.org/10.1212/WNL.0000000000003910

Racial differences in statin adherence following hospital discharge for ischemic stroke. / Albright, Karen C.; Zhao, Hong; Blackburn, Justin; Limdi, Nita A.; Beasley, T. Mark; Howard, George; Bittner, Vera; Howard, Virginia J.; Muntner, Paul.

In: Neurology, Vol. 88, No. 19, 09.05.2017, p. 1839-1848.

Research output: Contribution to journalArticle

Albright, KC, Zhao, H, Blackburn, J, Limdi, NA, Beasley, TM, Howard, G, Bittner, V, Howard, VJ & Muntner, P 2017, 'Racial differences in statin adherence following hospital discharge for ischemic stroke', Neurology, vol. 88, no. 19, pp. 1839-1848. https://doi.org/10.1212/WNL.0000000000003910
Albright, Karen C. ; Zhao, Hong ; Blackburn, Justin ; Limdi, Nita A. ; Beasley, T. Mark ; Howard, George ; Bittner, Vera ; Howard, Virginia J. ; Muntner, Paul. / Racial differences in statin adherence following hospital discharge for ischemic stroke. In: Neurology. 2017 ; Vol. 88, No. 19. pp. 1839-1848.
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abstract = "Objective: To compare nonadherence to statins in older black and white adults following an ischemic stroke. Methods: We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80{\%} in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately. Results: Overall 2,763 beneficiaries met the inclusion criteria (13.5{\%} black). Black adults were more likely than white adults to be nonadherent (49.7{\%} vs 41.5{\%}) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95{\%} confidence interval [CI] 1.01-1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95{\%} CI 1.02-1.26), history of coronary heart disease (adjusted RR 1.15, 95{\%} CI 1.01-1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95{\%} CI 1.10-1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95{\%} CI 1.01-1.09), history of carotid artery disease (adjusted RR 2.38, 95{\%} CI 1.08-5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95{\%} CI 1.01-1.78) were associated with nonadherence. Conclusions: Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.",
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T1 - Racial differences in statin adherence following hospital discharge for ischemic stroke

AU - Albright, Karen C.

AU - Zhao, Hong

AU - Blackburn, Justin

AU - Limdi, Nita A.

AU - Beasley, T. Mark

AU - Howard, George

AU - Bittner, Vera

AU - Howard, Virginia J.

AU - Muntner, Paul

PY - 2017/5/9

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N2 - Objective: To compare nonadherence to statins in older black and white adults following an ischemic stroke. Methods: We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately. Results: Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01-1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02-1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01-1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10-1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01-1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08-5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01-1.78) were associated with nonadherence. Conclusions: Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.

AB - Objective: To compare nonadherence to statins in older black and white adults following an ischemic stroke. Methods: We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately. Results: Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01-1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02-1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01-1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10-1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01-1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08-5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01-1.78) were associated with nonadherence. Conclusions: Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.

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