Abstract 3727: Meeting Quality of Care Goals for Hypercholesterolemia: Understanding Deficiencies for Women and Black Men Compared With Non-Black Men
BACKGROUND: CAD risk reduction requires maintaining LDL cholesterol (LDL) below NCEP goals. We examined time to LDL control for women and black men versus non-black men and examined the role of demographic, clinical, or health care factors in observed differences.
METHODS: Among 35,165 patients at 6 academic primary care practices from 1/1/03 to 2/8/05, we used electronic medical records to identify 11,536 patients at increased risk of CAD due to hypertension (HTN) and age (>45 if male and >55 if female) and an LDL from 1/1/00 to 2/28/05. For 6,497 patients (56%), the last LDL was high (i.e., ≥130 mg/dl or high risk ≥100 mg/dl) before or at the start of our timeframe. We studied 5,146 patients with 2+ visits after that LDL and complete data. Hazard ratios (HR) for the outcome - LDL control - came from survival (Cox) models with censoring 6 months after the last visit or the study end if no LDL control. Models adjust for demographics (age, income, insurance), clinical factors (discordant comorbidities such as asthma, concordant comorbidities such as CAD, smoking, obesity, LDL level), health care (N of HTN drugs, visits/month, provider gender, race, type, annual patient workload), and time from high LDL to next visit in study timeframe.
RESULTS: 47% of the cohort had LDL control within two years. Median days (d) to LDL control were: 456 d for non-black men (N=1,058); 627 d for non-black women (N=1,563); 698 d for black men (N=1,114); and 828 d for black women (N=2,164) (p<0.001). Compared to non-black men, adjusted HRs of LDL control were still lower for: non-black women (0.73, CI 0.64–0.82), black men (0.73, 0.63–0.85), and black women (0.59, CI 0.51–0.67). LDL control was positively associated with discordant comorbidities, anti-HTN drugs, age 61–80 vs <50, and shorter time from high LDL to next visit. Low income, Medicaid/uninsured vs commercial insured, and very high baseline LDL were negatively associated.
CONCLUSIONS: Among HTN patients at increased risk of CAD, time to LDL control was significantly longer for all women and black men than non-black men and not due to many patient and health care factors. Access to and acceptance/persistence with lipid-lowering medication likely contribute to these important disparities in CAD risk reduction.