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Objectives: To investigate the impact of statin adherence on clinical outcomes in the patients initiated with statin for primary and secondary prevention in China. Methods: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011)(2012)(2013)(2014)(2015). Adult patients initiated with statin (index date) with $2 prescriptions from 2012 through 2013 were included and followed for 24 months. Patients who experienced major adverse cardiovascular events (MACEs) in the initial 12-month follow-up were further excluded. Included patients were grouped into primary and secondary prevention subgroups according to whether they had cardiovascular disease or related surgery records during the prior 12-month baseline period. Patients with $0.5 of proportion of days covered (PDC) during the initial 12month follow-up were regarded as adherers. Propensity score matching (PSM) was conducted to form balanced pairs of adherers and non-adherers in primary and secondary prevention subgroups respectively. The incidence of MACEs during the 13th-24th months follow-up were compared between the matched adherers and non-adherers using Cox regression models. Results: 99,655 patients were identified, with 34.49% (65.51%) in primary (secondary) prevention subgroup. PSM selected 2,394 matched patients in primary prevention subgroup (47.37% female; mean age 52.7612.3 years), and the mean PDC were 0.6360.11 for the adherers and 0.1860.12 for non-adherers. Cox model showed that the adherers had a 62% reduced risk of MACEs compared with non-adherers in primary prevention subgroup (0.84% vs. 2.01%; adjusted HR=0.38, 95%CI, 0.18-0.80, P=0.011). Similar analyses were repeated in the secondary prevention subgroup (matched cohort: N=6,944), but no significant difference of risk of MACEs was observed between adheres and non-adheres (4.38% vs. 4.03%; adjusted HR=1.14, 95% CI, 0.91-1.44, P= 0.264). Conclusions: In patients initiated with statin for primary prevention, being adherent to statin is associated with decreased risk of adverse clinical outcomes in China. Further exploration is needed in secondary prevention group.

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Objectives: The common pharmacotherapy for Attention Deficit Hyperactivity Disorder (ADHD) includes the use of stimulants and non-stimulants. The objective of this study was to examine the prescribing practices of ADHD medications based on physician specialties and to determine the factors associated with their prescription among children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: This retrospective cross-sectional study used the National Ambulatory Medical Care Survey data (NAMCS) from 2011-2016. The study included children and adolescents (aged 4-17 years) with a diagnosis of ADHD identified using the International Classification of Diseases (ICD-9-CM ad ICD-10-CM) codes. Descriptive weighted analysis examined the prescribing practices of stimulants and non-stimulants, while multivariable logistic regression evaluated factors associated with ADHD medication use in general, and non-stimulants use in specific among children with ADHD. Results: During the study period, there were 50.3 million (95% CI: 42.5-58.1) visits by children and adolescents with ADHD. Most of patients were boys (69.85%), White (84.58%), and aged 9-12 years (39.84%). ADHD medications were prescribed in 79.80% of the patients. Stimulant medications were mainly prescribed by pediatricians (53.65%), while non-stimulants were mainly prescribed by psychiatrists (50.95%). The multivariable logistic regression revealed that Hispanics ([OR] = 0.55, 95% CI: 0.37-0.82) had a lower likelihood of being prescribed ADHD medications, while patients from South region (OR = 2.02, 95% CI: 1.19-3.42) had a greater likelihood of being prescribed ADHD medications as compared to West region. For non-stimulants, Hispanics (OR = 0.43, 95% CI: 0.19-0.97) were associated with a lower likelihood of non-stimulant prescription. Pediatric specialty (OR = 0.34, 95% CI: 0.12-0.97) was associated with decreased likelihood of prescribing nonstimulant medications, compared to psychiatric specialty. Conclusions: Stimulants and non-stimulants were commonly prescribed among children and adolescents with ADHD. Various demographic and provider factors were associated with prescription of ADHD medications.