Ethnicity/Race, Use of Pharmacotherapy, Scope of Physician-Ordered Cholesterol Screening, and Provision of Diet/Nutrition or Exercise Counseling during US Office-Based Visits by Patients with Hyperlipidemia

Willson, Megan N.; Neumiller, Joshua J.; Sclar, David A.; Robison, Linda M.; Skaer, Tracy L.

doi:10.2165/11532820-000000000-00000

Cited by 16 publications

(22 citation statements)

References 22 publications

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“…20 A 2005 National Ambulatory Medical Care Survey study reported less-aggressive lipid screening and management for blacks than whites. 21 This study builds on these prior observations by reporting findings by race–sex group across CHD risk categories, revealing that WM were likely driving previous findings.…”

Section: Discussionmentioning

confidence: 53%

Race–Sex Differences in the Management of Hyperlipidemia

Safford

Gamboa

Durant

et al. 2015

American Journal of Preventive Medicine

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Background Lipid management is less aggressive in blacks than whites and women than men. Purpose To examine whether differences in lipid management for race–sex groups compared to white men (WM) 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 (WW), 4,096 black men (BM), and 6,594 black women (BW). Except in the lowest risk group, BM were less aware of hyperlipidemia than others. A higher percentage of WM 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 BW 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 WM only in the highest risk category. Conclusions Hyperlipidemia was more aggressively treated and controlled among WM compared with WW, BM, and especially BW among those at highest risk for CHD. These differences were not attributable to factors influencing health services utilization.

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Section: Discussionmentioning

confidence: 53%

Race–Sex Differences in the Management of Hyperlipidemia

Safford

Gamboa

Durant

et al. 2015

American Journal of Preventive Medicine

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“…The US National Ambulatory Medical Care Survey from 2005 revealed marked inequities in assessment and management of dyslipidemia by respondents' race-ethnicity [17]. Among nearly 3,500 older primary care patients with hypertension and dyslipidemia, we use a novel approach to assessing the potency of prescribed lipid lowering therapy as a potential explanatory factor contributing to these inequities.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Cohort Study of the Potency of lipid-lowering therapy and Race-gender Differences in LDL cholesterol control

Turner

Hollenbeak

Weiner

et al. 2011

BMC Cardiovasc Disord

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BackgroundReasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.MethodsWe studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.ResultsTime to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.ConclusionsBlack women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.

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“…1,2 Latino individuals are less likely to be screened for high cholesterol than non-Hispanic whites, 3 even though they are at higher risk for the condition. 4–6 Obesity, a known risk factor for high cholesterol, 7,8 is more prevalent in the Latino population, 6,9 but obese Latinos are less likely to be counseled on weight reduction, 10,11 screened for elevated lipids, 11 and diagnosed with a lipid disorder. 12 Research in this area has largely utilized cross-sectional methods that are unable to track services over time, or has relied on surveys that are subject to recall and other biases, 13–17 which have produced mixed findings.…”

Section: Introductionmentioning

confidence: 99%

Lack of Lipid Screening Disparities in Obese Latino Adults at Health Centers

Heintzman

Bailey

Muench

et al. 2017

American Journal of Preventive Medicine

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Introduction In cross-sectional survey studies, obese Latinos are less likely to be screened for elevated serum cholesterol, despite their higher risk for hyperlipidemia and coronary artery disease. This study evaluated insurance and racial/ethnic disparities in lipid screening receipt among obese Latino and non-Hispanic white patients in Oregon community health centers (CHCs) over 5 years, using electronic health record data. Methods This retrospective cohort study evaluated obese (BMI≥30 kg/m2), low-income, adult patients (aged 21–79 years) with at least one visit at an Oregon CHC during 2009–2013 (N=11,095). Odds of lipid screening in the study period (clinical data collected in 2009–2013) were measured, adjusting for age, sex, primary clinic, and comorbidities, stratified by utilization in the study period. Analysis was done in 2016. Results Sixty percent of the study population received at least one lipid screening in 2009–2013. There were no significant differences in screening between insured Latinos and insured non-Hispanic whites, except those with more than five visits over 5 years (OR=0.75, 95% CI=0.60, 0.94). Uninsured Latinos had higher odds of screening versus insured non-Hispanic whites among the low visit strata (OR=1.65, 95% CI=1.18, 2.30). Among Latinos, Spanish preference resulted in higher screening odds versus English preference in the two to five visit stratum (OR=1.63, 95% CI=1.12, 2.35). Conclusions Obese, low-income patients at CHCs underutilize cholesterol screening. However, screening differences by race/ethnicity and preferred language are minimal. Further research is necessary to understand how care delivered by CHCs may mitigate previously reported disparities in lipid screening.

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Ethnicity/Race, Use of Pharmacotherapy, Scope of Physician-Ordered Cholesterol Screening, and Provision of Diet/Nutrition or Exercise Counseling during US Office-Based Visits by Patients with Hyperlipidemia

Cited by 16 publications

References 22 publications

Race–Sex Differences in the Management of Hyperlipidemia

Race–Sex Differences in the Management of Hyperlipidemia

A Retrospective Cohort Study of the Potency of lipid-lowering therapy and Race-gender Differences in LDL cholesterol control

Lack of Lipid Screening Disparities in Obese Latino Adults at Health Centers

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