Socioeconomic Disparities in the Use of Cardioprotective Medications Among Patients With Peripheral Artery Disease

Abstract

Objective Examine disparities in use of cardioprotective medications in treatment of peripheral artery disease (PAD) by socioeconomic status (SES). Background PAD is associated with increased cardiovascular risk and is more prevalent among those of lower SES. However, the use of guideline-recommended secondary preventive measures for the treatment of PAD across diverse income subgroups and the influence of practice site on potential treatment disparities by SES are unknown. Methods Within the National Cardiovascular Disease Registry (NCDR®) PINNACLE Registry®, 62,690 patients with PAD were categorized into quintiles of SES, as defined by the median income of each patient’s zip code. The association between SES and secondary prevention treatment with antiplatelet and statin medications was evaluated using sequential hierarchical modified Poison models, adjusting first for practice site and then for clinical variables. Results Compared with the highest SES quintile (median income >$60,868), PAD patients in the lowest SES quintile (median income <$34,486) were treated less often with statins (72.5 % vs. 85.8%; RR 0.84 [0.83–0.86]; P<0.001) and antiplatelet therapy (79.0% vs. 84.6 %; RR 0.93 [95% CI: 0.91–0.94]; P<0.001). These differences were markedly attenuated after controlling for practice site variation: statins (adjusted RR: 0.97 [0.95–0.99]; P=0.003) and antiplatelet therapy (adjusted RR 0.98 [0.97–1.00]; P=0.012). Additional adjustment for patients’ clinical characteristics had minimal impact with slight further attenuation: statins (adjusted RR: 1.00 [0.99–1.01]; p=0.772) and antiplatelet therapy (adjusted RR: 1.00 [0.99–1.01]; p=0.878). Conclusion Among PAD patients, the practice site at which patients received care largely explained the observed SES differences in treatment with guidelines-recommended secondary prevention medications. Future efforts to reduce treatment disparities in these vulnerable populations should target systems improvement at practices serving high proportions of patients with low SES.

Socioeconomic Inequality and Peripheral Artery Disease Prevalence in US Adults

“…In addition, despite recent work from Subherwal and colleagues demonstrating disparities in the use of cardiovascular medications among patients with PAD, we did not find that medication use affected the relationship between SES and prevalence of PAD. 21 …”

Socioeconomic Inequalities in Quality of Care and Outcomes Among Patients With Acute Coronary Syndrome in the Modern Era of Drug Eluting Stents

“…47 Furthermore, neighborhood income may represent geography and distance to hospitals. However, numerous previous studies have done the same 48–49 and prior evaluation has found disparities at both the ZIP code and individual level of analysis. 50 With regards to inequalities in PCI use, it is important to emphasize that we evaluated only patients presenting to the hospital with ACS, which does not include elective or outpatient PCI cases.…”

Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease: a cross-sectional study in North America

“… 32 In another study of patients with peripheral artery disease, patients living in low socioeconomic status areas, as defined by median household income, were less likely to receive statins than patients living in higher socioeconomic status areas. 28 Racial/ethnic differences in exercise participation, smoking and obesity have also been reported. 25 33 However, our work extends and broadens the findings of these studies because (1) our study focused on actively symptomatic patients, whose presentation may be attributable to gaps in prevention and (2) we simultaneously accounted for a wider range of sociodemographic characteristics.…”