A National Assessment of Medication Adherence to Statins by the Racial Composition of Neighborhoods

J Racial Ethn Health Disparities. 2017 Jun;4(3):462-471. doi: 10.1007/s40615-016-0247-7. Epub 2016 Jun 28.


Adherence to statins is lower in black and Hispanic patients and is linked to racial/ethnic disparities in cardiovascular mortality. Poverty, education, and prescription coverage differentials are typically invoked to explain adherence disparities, but analyses at the level of neighborhoods and their pharmacies may provide additional insights. Among individuals filling new statin prescriptions in a national pharmacy chain (N = 326,171), we compared adherence for patients residing in mostly minority neighborhoods to those living in mainly white areas. In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in black and Hispanic neighborhoods had 2-3 weeks less statin therapy over 1 year, a pattern not seen in Asian areas. In black and Hispanic neighborhoods, good adherence was associated with co-pays under $10, the use of 90-day refills, and payers other than Medicaid. Efforts to improve medication adherence for vulnerable populations may benefit from interventions at the level of local pharmacies, as well as medication benefit redesign.

Keywords: Cardiovascular disease; Medication adherence; Neighborhood; Pharmacies; Racial and ethnic disparities; Statin therapy.

MeSH terms

  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Racial Groups / statistics & numerical data*
  • Residence Characteristics / statistics & numerical data*
  • Retrospective Studies
  • United States


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors