title: Racial and ethnic differences in statin prescription and clinical outcomes among hospitalized patients with coronary heart disease.
abstract: We aimed to evaluate the association among race and ethnicity, statin prescription, and clinical outcomes among hospitalized patients with coronary heart disease (CHD), adjusted for confounders. Racial and ethnic disparities in CHD outcomes may be related to differential uptake of preventive medications, but data from real-world settings are limited. This was a 1-year prospective study of patients with preexisting CHD without a documented contraindication to statin (n = 3,067, 35% black or Hispanic, 65% white or Asian, 35% women) who participated in an National Heart, Lung and Blood Institute clinical outcome study of patients admitted to a cardiovascular service. Baseline clinical and medication data and 30-day and 1-year outcomes (death or rehospitalization) were documented by electronic medical record, National Death Index, and/or standardized mail survey. Logistic regression was used to evaluate associations among race and ethnicity, statin prescription, and outcomes adjusted for demographics and co-morbidities. Black and Hispanic patients were more likely to be dead or rehospitalized at 1 year (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.06 to 1.43) and less likely to report statin use before admission (62% vs 72%, adjusted OR 0.64, 95% CI 0.54 to 0.76) than whites and Asians; statin prescription was similar at discharge among blacks and Hispanics (81%) versus whites and Asians (84%). Black and Hispanic patients were more likely to have hypertension, diabetes, or renal failure and less likely to have health insurance than whites and Asians (p <0.05). The increased 1-year odds of death or rehospitalization in minorities versus whites and Asians were explained by demographics and co-morbidities not by differential statin prescription (adjusted OR 1.10, 95% CI 0.93 to 1.30). In conclusion, in this study of hospitalized patients with preexisting CHD, differential statin prescription did not explain racial and ethnic disparities in 1-year outcomes. Efforts to reduce CHD rehospitalizations should consider the greater burden of co-morbidities among racial and ethnic minorities.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Heidi
authors.initials: H
authors.lastname: Mochari-Greenberger
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Ming
authors.initials: M
authors.lastname: Liao
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York. Electronic address: ljm10@columbia.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Mosca
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000188:drug therapy / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007297:Inpatients; D008297:Male; D055553:Prescription Drugs; D011446:Prospective Studies; D044469:Racial Groups; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D055553:Prescription Drugs