Abstract WP416: African Americans are Less Likely to be Adherent to Statins After Ischemic Stroke: an Analysis of Medicare Beneficiaries Following Hospital Discharge
Introduction: Statins have been shown to decrease cardiovascular disease morbidity and mortality. Although statins have proven efficacious in reducing the risk of recurrent stroke, little is known about adherence among older adults following ischemic stroke.
Methods: We compiled a retrospective cohort of Caucasian and African-American Medicare beneficiaries in the 5% sample to estimate statin adherence among older adults initiating therapy following hospitalization for ischemic stroke in 2007 - 2011. To be included, beneficiaries were required to have 365 days of Medicare fee-for-service coverage with no claims for stroke-related events or statins prior to the index stroke event. The cohort was limited to beneficiaries with an initial Part D claim for a statin within 30 days plus at least 1 additional claim during follow-up. Adherence was determined by percent of days covered (PDC) for the 365 days following discharge home (time spent in rehabilitation or skilled nursing was excluded); non-adherence was defined as a PDC <80%. Relative risk of statin non-adherence was determined using modified Poisson regression.
Results: Among 6,251 statin-naïve beneficiaries with stroke, 2,070 (33.1%) initiated statin therapy and were included in the analysis. Among them, 13.1% (n=271) were African American. African Americans were more likely than Caucasians to have a PDC <80%, 15.4% vs. 11.7%, respectively (crude RR 1.21, 95% CI 1.04-1.40). The racial disparity remained after adjusting for demographics, dual Medicare-Medicaid eligibility, and baseline comorbidities (adjusted RR 1.17, 95% CI 0.99-1.37).
Conclusions: African Americans may not be obtaining the recurrent stroke prevention therapy provided by statins, possibly contributing to the higher rate of recurrent stroke in this population.
Author Disclosures: K.C. Albright: None. J. Blackburn: None. V. Howard: None. T. Beasley: None. N. Limdi: None. H. Zhao: None. P. Muntner: None.
This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate – Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico, Tennessee, U.S. Virgin Islands.
- © 2016 by American Heart Association, Inc.