Factors associated with county-level variation in the prescription of statins

Steph A. Karpinski, Kevin A. Look, David J. Vanness

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The American College of Cardiology/American Heart Association recommends statins for adults aged 40-75 years with a cardiovascular disease risk factor and a 10-year risk of cardiovascular events of 7.5%-19.9%. OBJECTIVE: To examine the association of county-level social determinant measures of health and composition of health services with use of statin prescriptions under Medicare Part D. METHODS: We used 2013 Medicare Part D prescriber county-level data to construct 2 measures of statin use: (1) statin beneficiaries ÷ total beneficiaries (prevalence [βPR]) and (2) statin days supplied ÷ (total beneficiaries × 365; adequacy of supply [βAS]). We used multivariable regression to estimate the association of each measure with county-level demographics and health service measures. RESULTS: A 1 standard deviation (SD) increase in the proportion of African Americans living in a county is associated with a 0.096 SD decrease in adequacy of supply (βAS = -0.096; 95% CI = -0.14 to -0.06). The proportion of county residents aged 65+ years who are female was associated with higher prevalence and adequacy of supply (βPR = 0.06; 95% CI = 0.02 to 0.11; βAS = 0.09; 95% CI = 0.05 to 0.14). Counties with higher proportions of Medicare Part D prescription expenditures receiving low-income subsidies had lower adequacy of supply (βAS = -0.28; 95% CI = -0.32 to -0.23). Counties with a higher proportion of Medicare Part D prescribers who are nurse practitioners was associated with lower prevalence and adequacy of supply (βPR = -0.39; 95% CI = -0.44 to -0.35; βAS = -0.42; 95% CI = -0.47 to -0.37). CONCLUSIONS: Race and ethnicity, income, and distribution of provider types were significantly associated with county-level variation in statin use, despite being unlikely to measure differences in actual medical need. Such variation more likely reflects predisposing and enabling factors potentially affected by social, economic, and public health policy. Tracking variation in county-level statin use associated with these factors could help policymakers assess progress in reducing health care disparities and better target program resources.

Original languageEnglish (US)
Pages (from-to)1358-1365
Number of pages8
JournalJournal of Managed Care and Specialty Pharmacy
Volume25
Issue number12
StatePublished - Jan 1 2019

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Prescriptions
Medicare Part D
Health
Causality
Health Services
Healthcare Disparities
Association reactions
Social Determinants of Health
Nurse Practitioners
Public health
Public Policy
Health Expenditures
Health Policy
Health care
African Americans
Health Status
Cardiovascular Diseases
Public Health
Economics

All Science Journal Classification (ASJC) codes

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

@article{165c969c756d4a96bb6df9e5ccc337f1,
title = "Factors associated with county-level variation in the prescription of statins",
abstract = "BACKGROUND: The American College of Cardiology/American Heart Association recommends statins for adults aged 40-75 years with a cardiovascular disease risk factor and a 10-year risk of cardiovascular events of 7.5{\%}-19.9{\%}. OBJECTIVE: To examine the association of county-level social determinant measures of health and composition of health services with use of statin prescriptions under Medicare Part D. METHODS: We used 2013 Medicare Part D prescriber county-level data to construct 2 measures of statin use: (1) statin beneficiaries ÷ total beneficiaries (prevalence [βPR]) and (2) statin days supplied ÷ (total beneficiaries × 365; adequacy of supply [βAS]). We used multivariable regression to estimate the association of each measure with county-level demographics and health service measures. RESULTS: A 1 standard deviation (SD) increase in the proportion of African Americans living in a county is associated with a 0.096 SD decrease in adequacy of supply (βAS = -0.096; 95{\%} CI = -0.14 to -0.06). The proportion of county residents aged 65+ years who are female was associated with higher prevalence and adequacy of supply (βPR = 0.06; 95{\%} CI = 0.02 to 0.11; βAS = 0.09; 95{\%} CI = 0.05 to 0.14). Counties with higher proportions of Medicare Part D prescription expenditures receiving low-income subsidies had lower adequacy of supply (βAS = -0.28; 95{\%} CI = -0.32 to -0.23). Counties with a higher proportion of Medicare Part D prescribers who are nurse practitioners was associated with lower prevalence and adequacy of supply (βPR = -0.39; 95{\%} CI = -0.44 to -0.35; βAS = -0.42; 95{\%} CI = -0.47 to -0.37). CONCLUSIONS: Race and ethnicity, income, and distribution of provider types were significantly associated with county-level variation in statin use, despite being unlikely to measure differences in actual medical need. Such variation more likely reflects predisposing and enabling factors potentially affected by social, economic, and public health policy. Tracking variation in county-level statin use associated with these factors could help policymakers assess progress in reducing health care disparities and better target program resources.",
author = "Karpinski, {Steph A.} and Look, {Kevin A.} and Vanness, {David J.}",
year = "2019",
month = "1",
day = "1",
language = "English (US)",
volume = "25",
pages = "1358--1365",
journal = "Journal of managed care & specialty pharmacy",
issn = "2376-0540",
publisher = "Academy of Managed Care Pharmacy (AMCP)",
number = "12",

}

Factors associated with county-level variation in the prescription of statins. / Karpinski, Steph A.; Look, Kevin A.; Vanness, David J.

In: Journal of Managed Care and Specialty Pharmacy, Vol. 25, No. 12, 01.01.2019, p. 1358-1365.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with county-level variation in the prescription of statins

AU - Karpinski, Steph A.

AU - Look, Kevin A.

AU - Vanness, David J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: The American College of Cardiology/American Heart Association recommends statins for adults aged 40-75 years with a cardiovascular disease risk factor and a 10-year risk of cardiovascular events of 7.5%-19.9%. OBJECTIVE: To examine the association of county-level social determinant measures of health and composition of health services with use of statin prescriptions under Medicare Part D. METHODS: We used 2013 Medicare Part D prescriber county-level data to construct 2 measures of statin use: (1) statin beneficiaries ÷ total beneficiaries (prevalence [βPR]) and (2) statin days supplied ÷ (total beneficiaries × 365; adequacy of supply [βAS]). We used multivariable regression to estimate the association of each measure with county-level demographics and health service measures. RESULTS: A 1 standard deviation (SD) increase in the proportion of African Americans living in a county is associated with a 0.096 SD decrease in adequacy of supply (βAS = -0.096; 95% CI = -0.14 to -0.06). The proportion of county residents aged 65+ years who are female was associated with higher prevalence and adequacy of supply (βPR = 0.06; 95% CI = 0.02 to 0.11; βAS = 0.09; 95% CI = 0.05 to 0.14). Counties with higher proportions of Medicare Part D prescription expenditures receiving low-income subsidies had lower adequacy of supply (βAS = -0.28; 95% CI = -0.32 to -0.23). Counties with a higher proportion of Medicare Part D prescribers who are nurse practitioners was associated with lower prevalence and adequacy of supply (βPR = -0.39; 95% CI = -0.44 to -0.35; βAS = -0.42; 95% CI = -0.47 to -0.37). CONCLUSIONS: Race and ethnicity, income, and distribution of provider types were significantly associated with county-level variation in statin use, despite being unlikely to measure differences in actual medical need. Such variation more likely reflects predisposing and enabling factors potentially affected by social, economic, and public health policy. Tracking variation in county-level statin use associated with these factors could help policymakers assess progress in reducing health care disparities and better target program resources.

AB - BACKGROUND: The American College of Cardiology/American Heart Association recommends statins for adults aged 40-75 years with a cardiovascular disease risk factor and a 10-year risk of cardiovascular events of 7.5%-19.9%. OBJECTIVE: To examine the association of county-level social determinant measures of health and composition of health services with use of statin prescriptions under Medicare Part D. METHODS: We used 2013 Medicare Part D prescriber county-level data to construct 2 measures of statin use: (1) statin beneficiaries ÷ total beneficiaries (prevalence [βPR]) and (2) statin days supplied ÷ (total beneficiaries × 365; adequacy of supply [βAS]). We used multivariable regression to estimate the association of each measure with county-level demographics and health service measures. RESULTS: A 1 standard deviation (SD) increase in the proportion of African Americans living in a county is associated with a 0.096 SD decrease in adequacy of supply (βAS = -0.096; 95% CI = -0.14 to -0.06). The proportion of county residents aged 65+ years who are female was associated with higher prevalence and adequacy of supply (βPR = 0.06; 95% CI = 0.02 to 0.11; βAS = 0.09; 95% CI = 0.05 to 0.14). Counties with higher proportions of Medicare Part D prescription expenditures receiving low-income subsidies had lower adequacy of supply (βAS = -0.28; 95% CI = -0.32 to -0.23). Counties with a higher proportion of Medicare Part D prescribers who are nurse practitioners was associated with lower prevalence and adequacy of supply (βPR = -0.39; 95% CI = -0.44 to -0.35; βAS = -0.42; 95% CI = -0.47 to -0.37). CONCLUSIONS: Race and ethnicity, income, and distribution of provider types were significantly associated with county-level variation in statin use, despite being unlikely to measure differences in actual medical need. Such variation more likely reflects predisposing and enabling factors potentially affected by social, economic, and public health policy. Tracking variation in county-level statin use associated with these factors could help policymakers assess progress in reducing health care disparities and better target program resources.

UR - http://www.scopus.com/inward/record.url?scp=85075782027&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075782027&partnerID=8YFLogxK

M3 - Article

C2 - 31778617

AN - SCOPUS:85075782027

VL - 25

SP - 1358

EP - 1365

JO - Journal of managed care & specialty pharmacy

JF - Journal of managed care & specialty pharmacy

SN - 2376-0540

IS - 12

ER -