Regular aspirin use among a sample of American Indians/Alaskan Natives in the Upper Midwest region of the United States

Sarah M Alabsi; Sue Duval; Michael Sundberg; Donovan Williams; Russell V Luepker; Milton Eder; Jeremy R Van't Hof

doi:10.1016/j.pmedr.2023.102571

Regular aspirin use among a sample of American Indians/Alaskan Natives in the Upper Midwest region of the United States

Prev Med Rep. 2023 Dec 20:37:102571. doi: 10.1016/j.pmedr.2023.102571. eCollection 2024 Jan.

Authors

Sarah M Alabsi¹, Sue Duval², Michael Sundberg³, Donovan Williams⁴, Russell V Luepker^{2

5}, Milton Eder⁶, Jeremy R Van't Hof²

Affiliations

¹ University of Minnesota Medical School, Minneapolis MN, USA.
² Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis MN, USA.
³ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁴ Division of Geriatrics, Palliative and Primary Care, University of Minnesota Medical School, Minneapolis MN, USA.
⁵ University of Minnesota School of Public Health, Division of Epidemiology and Public Health, Minneapolis, MN, USA.
⁶ Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.

Abstract

Despite high prevalence of cardiovascular disease (CVD) and CVD risk factors among American Indian or Alaska Native adults (AI/AN), there is little information on aspirin use in this population. This survey-based study seeks to understand prevalence of aspirin use in a sample of AI/AN adults in the Upper Midwestern United States. In-person and telephone based surveys were conducted querying self-reported CVD and CVD risk factors, aspirin use, and aspirin related discussion with clinicians. A total of 237 AI/AN participants were included: mean age (SD) was 60.8 (8.4) years; 143 (60 %) were women; 59 (25 %) reported CVD history. CVD risk factors were common particularly smoking (37 %) and diabetes (37 %). Aspirin use was much higher among those with CVD (secondary prevention, 76 %) than those without (primary prevention, 33 %). Primary prevention aspirin use was significantly associated with age and all CVD risk factors in unadjusted analyses. After adjustment for demographics and CVD risk factors, only age (aRR 1.13 per 5 years, 95 % CI 1.02, 1.25) and diabetes (aRR 2.44, 95 % CI 1.52, 3.92) remained significantly associated with aspirin. Regardless of CVD status, a higher proportion of those taking aspirin reported a conversation about aspirin with their doctor compared to those not taking aspirin. Among participants with no CVD, those who had such a conversation were 2.6 times more likely to use aspirin than those who did not have a conversation (aRR 2.64, 95 % CI 1.58, 4.44). The findings of this study emphasize the importance of the patient-provider relationship for preventive therapy.

Keywords: Alaska Native; American Indian; Aspirin use; Patient-provider relationship; Preventive therapy; Provider communication; Underserved population.

Grants and funding

R01 HL126041/HL/NHLBI NIH HHS/United States