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. 2023 Oct 26;10(4):369-379.
doi: 10.15326/jcopdf.2023.0395.

Disparities in Guideline Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease

Jamuna K Krishnan  1 , Sonal G Mallya  2   3 , Musarrat Nahid  3 , Aaron D Baugh  4 , MeiLan K Han  5 , Kerri I Aronson  1 , Parag Goyal  3   6 , Laura C Pinheiro  3 , Samprit Banerjee  7 , Fernando J Martinez  1 , Monika M Safford  3
Affiliations

Disparities in Guideline Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease

Jamuna K Krishnan et al. Chronic Obstr Pulm Dis. .

Abstract

Rationale: Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown.

Objectives: We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort.

Methods: We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact health care utilization.

Results: Of the 2032 members within the COPD sub-cohort with sufficient data, 1435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence health care utilization, Black women (PR 0.76, 95% confidence interval [CI] 0.67 to 0.86) and White women (PR 0.84 95% CI 0.76 to 0.91) remained less likely to be treated compared to White men.

Conclusions: All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual health care utilization factors, suggesting structural interventions are needed.

Keywords: COPD; cardiovascular disease; comorbidity; health delivery.

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Conflict of interest statement

JKK reports support from the NIH, and the Weill Cornell Medicine Dean’s Diversity and Healthcare Disparity Research Award directly related to the submitted manuscript. She also reports financial support from the American Thoracic Society Fellowship in Health Equity, the Donna Redel Research Fund, and the Weill Cornell Research Assistance for Primary Parents Award and receipt of medication samples from Novartis, GSK, and Boehringer Ingelheim to the institution. SGM, MN, ADB, LCP, and PG report no conflicts of interest. MKH reports grants/contracts from the NIH, Sanofi, Novartis, Nuvaira, Sunovion, Gala Therapeutics, the COPD Foundation, AstraZeneca, GSK, Boehringer Ingelheim, the American Lung Association, and Biodesix. She also reports data safety monitoring board/advisory board participation for Novartis and Medtronic, leadership roles with the COPD Foundation, the American Lung Association, the American Thoracic Society, and the GOLD Scientific Committee; stocks in Meissa Vaccines and Altesa Biopharma; royalties/licenses from UpToDate, Norton Publishing, and Penguin Random House; consulting fees from AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, United Therapeutics, Regeneron, and Altesa BioPharma; honoraria from Cipla, Chiesi, AstraZeneca, Boehringer Ingelheim, GSK, Medscape, Integrity, NACE; and personal fees from Medscape and Integrity. FJM reports grants/contracts from AstraZeneca, Chiesi, GSK, Sanofi/Regeneron; consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Novartis, Polarean, Pulmonx, Sanofi/Regeneron, Sunovion, Teva, Theravance/Viatris, UpToDate; honoraria from AstraZeneca and GSK; and data safety monitoring board/advisory board participation in MedTronic and GSK. KIA reports funding from the NHLBI, the Scleroderma Foundation, the American Lung Association, and the Stony-Wold Herbert Fund; and leadership roles as a member of the Pulmonary Fibrosis Foundation Scientific Review Committee and PCORI merit reviewer. SB reports a position on the data safety monitoring board for the Optimizing a Closed-Loop Digital Meditation Intervention for Remediating Cognitive Decline and Reducing Stress in Older Adults study. MMS reports support for the present manuscript with NHLBI grant R01HL80477.

References

    1. Sin DD,Wu L,Anderson JA,et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax. 2005;60(12):992-997. doi: https://doi.org/10.1136/thx.2005.045385 - PMC - PubMed
    1. McGarvey LP,John M,Anderson JA,Zvarich M,Wise RA. TORCH Clinical Endpoint Committee. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax. 2007;62(5):411-415. doi: https://doi.org/10.1136/thx.2006.072348 - PMC - PubMed
    1. Anthonisen NR,Skeans MA,Wise RA,et al. The effects of a smoking cessation intervention on 14. 5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233-239. doi: https://doi.org/10.7326/0003-4819-142-4-200502150-00005 - PubMed
    1. Chen W,Thomas J,Sadatsafavi M,FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631-639. doi: https://doi.org/10.1016/S2213-2600(15)00241-6 - PubMed
    1. Mannino DM,Thorn D,Swensen A,Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32(4):962-969. doi: https://doi.org/10.1183/09031936.00012408 - PubMed