title: Race-sex differences in the management of hyperlipidemia: the REasons for Geographic and Racial Differences in Stroke study.
abstract: BACKGROUND
  Lipid management is less aggressive in blacks than whites and women than men.
  
  
  OBJECTIVE
  To examine whether differences in lipid management for race-sex groups compared to white men are due to factors influencing health services utilization or physician prescribing patterns.
  
  
  METHODS
  Because coronary heart disease (CHD) risk influences physician prescribing, Adult Treatment Panel III CHD risk categories were constructed using baseline data from REasons for Geographic And Racial Differences in Stroke study participants (recruited 2003-2007). Prevalence, awareness, treatment, and control of hyperlipidemia were examined for race-sex groups across CHD risk categories. Multivariable models conducted in 2013 estimated prevalence ratios adjusted for predisposing, enabling, and need factors influencing health services utilization.
  
  
  RESULTS
  The analytic sample included 7,809 WM; 7,712 white women; 4,096 black men; and 6,594 black women. Except in the lowest risk group, black men were less aware of hyperlipidemia than others. A higher percentage of white men in the highest risk group was treated (83.2%) and controlled (72.8%) than others (treatment, 68.6%-72.1%; control, 52.2%-65.5%), with black women treated and controlled the least. These differences remained significant after adjustment for predisposing, enabling, and need factors. Stratified analyses demonstrated that treatment and control were lower for other race-sex groups relative to white men only in the highest risk category.
  
  
  CONCLUSIONS
  Hyperlipidemia was more aggressively treated and controlled among white men compared with white women, black men, and especially black women among those at highest risk for CHD. These differences were not attributable to factors influencing health services utilization.
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: msafford@uab.edu.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gamboa
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Raegan W
authors.initials: RW
authors.lastname: Durant
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Brown
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Glasser
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.affiliation: Sentara Healthcare & Department of Neurology, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Zweifler
authors.affiliation: Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005843:Geography; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D020521:Stroke / Q000208:ethnology*