title: Racial differences in statin adherence following hospital discharge for ischemic stroke.
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.
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham. kca@uab.edu.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Justin
authors.initials: J
authors.lastname: Blackburn
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Nita A
authors.initials: NA
authors.lastname: Limdi
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: From the Geriatric Research, Education and Clinical Center (GRECC) (K.C.A.), Birmingham VA Medical Center; and the Departments of Epidemiology (K.C.A., H.Z., N.A.L., V.J.H., P.M.), Health Care Organization and Policy (J.B.), Neurology (N.A.L.), and Biostatistics (T.M.B., G.H.), and the Division of Cardiovascular Disease, Department of Medicine (V.B.), University of Alabama at Birmingham.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D001741:Black or African American; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000208:ethnology; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000208:ethnology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D006278:Medicare; D055118:Medication Adherence / Q000208:ethnology*; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D057566:Self Report; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D014481:United States; D044465:White People
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors