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Clinical Trial
. 2017 Aug 2;6(8):e005523.
doi: 10.1161/JAHA.117.005523.

Age and Sex Disparities in Discharge Statin Prescribing in the Stroke Belt: Evidence From the Reasons for Geographic and Racial Differences in Stroke Study

Karen C Albright  1   2 , Virginia J Howard  2 , George Howard  3 , Paul Muntner  2 , Vera Bittner  4 , Monika M Safford  4 , Amelia K Boehme  5 , J David Rhodes  3 , T Mark Beasley  3 , Suzanne E Judd  3 , Leslie A McClure  3 , Nita Limdi  6 , Justin Blackburn  7
Affiliations
Clinical Trial

Age and Sex Disparities in Discharge Statin Prescribing in the Stroke Belt: Evidence From the Reasons for Geographic and Racial Differences in Stroke Study

Karen C Albright et al. J Am Heart Assoc. .

Abstract

Background: Stroke is a costly and debilitating disease that disproportionately affects blacks. Despite the efficacy of statins, evidence suggests racial disparities may exist in statin prescribing.

Methods and results: We analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Medications on admission and discharge were abstracted from medical records. Among the 666 eligible incident strokes (2003-2013), analyses were restricted to 323 participants who were not statin users at the time of admission and had no history of atrial fibrillation. Overall, 48.7% were prescribed a statin on discharge. In the Stroke Belt, participants aged 65 years and older were 47% less likely to be discharged on a statin compared with those younger than 65 years (relative risk [RR], 0.53; 95% CI, 0.38-0.74). This association was not observed in non-Stroke Belt residents. Outside the Stroke Belt, blacks were more likely than whites to be discharged on a statin (RR, 1.42; 95% CI, 1.04-1.94), while no black:white association was present among Stroke Belt residents (RR, 0.93; 95% CI, 0.69-1.26; P for interaction=0.228). Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR, 0.69; 95% CI, 0.50-0.94) while men outside the Stroke Belt were more likely to be discharged on a statin (RR, 1.38; 95% CI, 0.99-1.92; P for interaction=0.004).

Conclusions: Statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.

Keywords: disparities; prescribing patterns; secondary prevention; statins; stroke.

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Figures

Figure 1
Figure 1
Flow diagram of exclusion criteria applied to achieve the final statin (HMG‐CoA reductase inhibitors) cohort. REGARDS indicates Reasons for Geographic and Racial Differences in Stroke study.
Figure 2
Figure 2
Proportion of participants prescribed a statin (HMG‐CoA reductase inhibitors) at discharge by year.
See this image and copyright information in PMC

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