Is race or ethnicity associated with under‐utilization of statins among women in the United States: The study of women's health across the nation

Jackson, Elizabeth A.; Ruppert, Kristine; Derby, Carol A.; Lian, Yinjuan; Chae, Claudia U.; Kazlauskaite, Rasa; Neal‐Perry, Genevieve; Khoudary, Samar R. El; Harlow, Sioḃán D.; Solomon, Daniel H.

doi:10.1002/clc.23448

Cited by 11 publications

(5 citation statements)

References 42 publications

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“…40,62 For Black women in particular, additional funding is needed to prioritize maternal education and health advocacy during prenatal, antepartum, and postpartum periods (ie, education on risk assessment, disparities, individual cardiovascular health, routine checkups). [63][64][65] At the policy level, more initiatives are needed to protect Black men from deleterious systems that perpetuate poor cardiovascular health outcomes (ie, the criminal justice system and mass incarceration of Black men 7 ).…”

Section: Discussionmentioning

confidence: 99%

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

et al. 2022

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Background: Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. Methods: We used CDC WONDER (Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. Results: From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9–160.3]; 2019: ARD, 84.3 [95% CI, 81.2–87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6–194.6]; 2019: ARD, 130.3 [95% CI, 125.6–135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30–1.33])— especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23–2.32])—as well as for Black men (rate ratio, 1.33 [95% CI, 1.32–1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. Conclusions: During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

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Section: Discussionmentioning

confidence: 99%

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

et al. 2022

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“…However, they were more likely to have untreated hypertension (16.9% vs. 7.9%) and, given treatment, less likely to have controlled hypertension (50.0% vs. 76.8%). At follow visit 12, we evaluated statin use [ 91 ]: 32% of Black women and 29% of White women met the 2013 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines criteria for statin use. Among those who met the criteria, 41% of Black women and 49% of White women reported using statins.…”

Section: Resultsmentioning

confidence: 99%

Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN)

Harlow

Burnett-Bowie

Greendale

et al. 2022

womens midlife health

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This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women’s Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women’s outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women’s health – menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function –and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN’s design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.

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“…It is difficult to establish conclusions about the relationship between gender and adherence because we have evidence suggesting better adherence in males as well as in females. [ 8 9 10 11 ] Therefore, it is challenging to determine the association of such a small cohort and thus a larger cohort needs to be analyzed to establish this association.…”

Section: Discussionmentioning

confidence: 99%

Impact of Adherence, Patient Perception, and Knowledge to Statin Therapy – A Cross-Sectional Study

Raut

Umarje

James

et al. 2021

Indian Journal of Endocrinology and Metabolism

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Background and Objective: Cardiovascular diseases and its risk factors, such as diabetes and hyperlipidemia, are common in Indian population. Statin utilization is high across the country and it is important to assess the adherence because it plays an important role in treatment outcome. Statin adherence is not studied well in India. This study aims at measuring the adherence, perception, and knowledge of individuals on statin therapy. Study Design: Cross-sectional observational study on 130 consented individuals visiting a tertiary care teaching hospital. Study was conducted for a duration of 9 months. Methods and Materials: After obtaining approval from the institutional ethics committee the study subjects were assessed for knowledge, perception, and adherence to statin therapy using a systematically developed interview questionnaire. Results: Good adherence was seen in 42.30% patients. Higher proportions of females were reported to have good adherence. Good adherence was observed in patients with a history of coronary heart disease and atorvastatin as monotherapy ( P = 0.0029) and fixed dose combination ( P = 0.0012), whereas lipid reduction was found directly related to type of adherence. Lack of knowledge, cost, re-fill issues, and adverse effects were some of the barriers identified. Interpretation and Conclusion: Knowledge and patient perception plays a very important role in determining the adherence to statin therapy. A history of coronary heart disease, choice of statin, and cost of therapy are the contributing factors to adherence. Patient counselling and improving the cost-effectiveness of statin therapy can be considered as interventional strategies to overcome adherence issues.

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Is race or ethnicity associated with under‐utilization of statins among women in the United States: The study of women's health across the nation

Cited by 11 publications

References 42 publications

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN)

Impact of Adherence, Patient Perception, and Knowledge to Statin Therapy – A Cross-Sectional Study

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