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Lower Statin Prescription Rate for
Blacks, Hispanics With HIV in US Military
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Compared with HIV-positive whites in the US military, blacks and Hispanics with a need for statin therapy got prescriptions for the lipid-lowering drugs substantially less often [1]. The findings are compelling because active duty service people and military retirees have stable incomes and access to health care regardless of race or ethnicity.
US Military HIV Natural History Study (NHS) researchers observed that racial disparities in healthcare persist in the United States, particularly in people with HIV. Some work attributes these disparities to poverty, unstable access to care, poor health insurance, or poor health literacy. Clinician behavior and communication or racial barriers have also been implicated. To address these issues, NHS investigators undertook this study of disparities in cardiovascular disease prevention in their diverse cohort of active duty members and pensioned retirees with good access to healthcare.
The NHS enrolls HIV-positive beneficiaries of the Department of Defense healthcare system. This retrospective cross-sectional analysis focused on adherence to guidelines for statin therapy in 1223 cohort members 21 to 75 years old who had a study visit in 2016. The investigators determined statin eligibility with 2013 American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic cardiovascular disease management guidelines. The outcome of interest was statin prescription during the study or in the prior 6 months divided by ACC/AHA-determined statin eligibility.
The analysis focused on 476 whites, 557 blacks, and 190 Hispanic/other military beneficiaries. The white, black, and Hispanic groups differed significantly in age (49.0, 45.5, 37.9, P < 0.0001) and proportion with an HIV diagnosis after 1996 (66%, 68.4%, 81%, P = 0.0024), but not in proportions of men (about 95% overall), nadir CD4 count (about 320 overall), latest CD4 count (about 700), or antiretroviral adherence (100% in all groups).
Among all participants, the statin prescription rate was higher among whites than blacks or Hispanics (33.6% vs 21.7% vs 11.1%). Among cohort member with a statin indication, prescription rates were also substantially higher in whites than in blacks or Hispanics (62.2% vs 47.1% vs 42.3%).
Among cohort members with previous cardiovascular disease, guideline-concordant statin prescription rates were the same in whites and blacks (77.8%) and lower in Hispanics (60.0%). Among people with diabetes, statin prescription rates were higher in whites (72.2%) than in blacks (54.2%) or Hispanics (25.0%). Among people with an atherosclerotic cardiovascular disease risk above 7.5%, prescription rates were again higher in whites (62.3%) than in blacks (47.7%) or Hispanics (39.1%).
The researchers stressed that racial disparities in statin prescribing persist in military personnel and retirees even though these groups have stable income, open access to healthcare and medications, and low rates of injection drug use. They suggested that differences in statin guideline adherence could reflect patient-, provider-, or system-level factors. The investigators suggested their findings challenge the premise that socioeconomic factors explain race-based disparities in cardiovascular disease prevention.
Reference
1. Larson DT, Won S, Deiss RG, et al. Disparities in cardiovascular disease prevention among persons living with HIV in the United States Military Natural History Study. IDWeek, October 2-6, 2019, Washington, DC. Abstract 336.
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