Abstract 15724: Prevalence of Statin Use among Medicare Beneficiaries with Coronary Heart Disease by Income, Region, and Race/Ethnicity

Abstract

Background: To meet LDL-cholesterol treatment goals, patients with coronary heart disease (CHD) often need lipid-lowering drugs such as statins. With Medicare Part D, prescription drug insurance is available for older individuals; it is not known if statin use varies by income, region, and race/ethnicity in older adults with CHD.

Methods: From a 2009 5% random sample of Medicare beneficiaries, we identified individuals ≥ 65 years old with CHD (diagnosis of acute myocardial infarction, unstable angina, or other coronary artery disease, or revascularization). Statin use was defined as ≥1 filled prescription for a statin (identified by National Drug Codes) in 2009. Area-level income and region were characterized using US Census data. Race/ethnicity was self-reported at Medicare enrollment. We calculated prevalence of statin use by income, region, and race/ethnicity and prevalence ratios from log-binomial models including age, sex, income, region, and race/ethnicity.

Results: Among 115,470 beneficiaries with CHD, 67.5% used statins (46.5% simvastatin, 28.6% atorvastatin, 10.0% rosuvastatin, 8.4% pravastatin, and 6.4% other statins). Statin use was 66.2%, 67.1%, 67.8%, 68.9%, and 70.2% in areas with incomes ≤$29,999, $30,000-44,999, $45,000-59,999, $60,000-74,999, and ≥$75,000, respectively. Use of statins varied from 65.0% in the Middle Atlantic to 71.3% in New England. Among black beneficiaries, 63.1% used statins compared to 67.7%, 67.2%, 71.3%, and 66.9% of white, Hispanic, Asian, and other race/ethnicity beneficiaries, respectively. In multivariable adjusted models, there were small, statistically significant (p < 0.001) associations of income, region, and race/ethnicity with statin use (Figure).

Conclusions: Prevalence of statin use among Medicare beneficiaries with CHD was related to demographic characteristics, with black individuals and those who live in lower-income areas slightly less likely to use statins.