Age and Sex Disparities in Discharge Statin Prescribing in the Stroke Belt: Evidence From the Reasons for Geographic and Racial Differences in Stroke Study.
Age and Sex Disparities in Discharge Statin Prescribing in the Stroke Belt: Evidence From the Reasons for Geographic and Racial Differences in Stroke Study.
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DOI：
10.1161/jaha.117.005523
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发表时间：
2017-08-02
影响因子：
5.4
通讯作者：
Blackburn J
中科院分区：
文献类型：
--
作者：
Albright KC;Howard VJ;Howard G;Muntner P;Bittner V;Safford MM;Boehme AK;Rhodes JD;Beasley TM;Judd SE;McClure LA;Limdi N;Blackburn J
中风是一种代价高昂且使人衰弱的疾病，对黑人的影响尤为严重。尽管他汀类药物有效，但有证据表明在他汀类药物的处方上可能存在种族差异。
我们分析了REGARDS（中风的地理和种族差异原因）研究随访期间因缺血性中风住院的参与者的出院用药情况。从病历中提取入院和出院时的用药情况。在666例符合条件的首发中风病例（2003 - 2013年）中，分析仅限于323名入院时未使用他汀类药物且无房颤病史的参与者。总体而言，48.7%的人在出院时被开具了他汀类药物。在中风带地区，65岁及以上的参与者在出院时被开具他汀类药物的可能性比65岁以下的参与者低47%（相对风险[RR]，0.53；95%置信区间，0.38 - 0.74）。在非中风带地区的居民中未观察到这种关联。在中风带地区之外，黑人比白人更有可能在出院时被开具他汀类药物（RR，1.42；95%置信区间，1.04 - 1.94），而在中风带地区的居民中，黑人与白人之间没有这种关联（RR，0.93；95%置信区间，0.69 - 1.26；交互作用P值 = 0.228）。与女性相比，中风带地区的男性在出院时被开具他汀类药物的可能性低31%（RR，0.69；95%置信区间，0.50 - 0.94），而中风带地区之外的男性更有可能在出院时被开具他汀类药物（RR，1.38；95%置信区间，0.99 - 1.92；交互作用P值 = 0.004）。
他汀类药物的出院处方情况在中风带地区和非中风带地区的居民之间可能存在差异，尤其是在老年美国人和男性中。
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. 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). Statin discharge prescribing may differ among Stroke Belt and non–Stroke Belt residents, particularly in older Americans and men.