Purpose: In 2008, the American Diabetes Association (ADA) recommended that patients aged >40 years with diabetes and cardiovascular disease or with ≥1 cardiovascular disease risk factor be prescribed a statin. This study assessed statin prescribing patterns in patients with diabetes, per the ADA guideline, using data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey-Outpatient Department for the years 2005 to 2010. This study also examined patients' demographic characteristics associated with statin prescribing, including sex, age, ethnicity, race, insurance type, body mass index, region, primary care provider, hypertension and hyperlipidemia.
Methods: This retrospective, cross-sectional, observational study included data dated between 2005 and 2010 from patients aged ≥18 years with diabetes and without contraindications to statin use. Associations between statin prescribing and variables of interest were analyzed using χ(2) tests. A multivariate logistic regression model included 2 groups stratified by 3-year observation period (2005-2007 and 2008-2010) plus all variables with an overall χ(2) test result of P < 0.2. P values, odds ratios (ORs) and 95% CIs are reported.
Findings: The majority of patients were aged ≥40 years (93.1%), had a body mass index of ≥30 (58.7%), had hypertension (65.6%), and did not have hyperlipidemia (54.0%). A low percentage of patients were prescribed a statin (35.1%), but it appears that this percentage is on the rise. During 2005-2007, 31.9% of patients received a statin, whereas 37.7% of patients received a statin during 2008-2010. After adjustment for covariates included in the multivariate logistic regression model, those with hypertension (vs none [reference]: OR = 1.31; 95% CI, 1.12-1.53) and/or hyperlipidemia (vs none [reference]: OR = 4.44; 95% CI, 3.70-5.33) were significantly more likely to have been prescribed a statin, whereas those in age group 18-<40 years (vs 40-<65 years [reference]: OR = 0.45; 95% CI, 0.31-0.65) and Hispanic/Latino patients (vs non-Hispanic/Latino patients [reference]: OR = 0.77; 95% CI, 0.61-0.97) were significantly less likely to have been prescribed a statin.
Implications: Despite the call in the latest ADA recommendations for prescribing statins in many diabetic patients, an unexpectedly low percentage of patients were receiving them. Health disparities in age and ethnicity were also evident. The findings from this study highlight the need for further research into low statin prescribing rates.
Keywords: diabetes; disparities; ethnicity; statins.
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