Prescription and over-the-counter medications play an important role in older adult health in the United States,1
including the prevention of morbidity and mortality from common chronic conditions such as cardiovascular disease (CVD).2-4
CVD is the leading cause of death5
and health disparities6
among older adults. Despite concerns about persistent racial/ethnic disparities in health7
and health care,8
including disparities in cardiovascular health,9,10
current information on disparities in the use prescription and over-the-counter medications for the prevention of CVD among older adults is limited. Racial and ethnic disparities in cardiovascular medication use among older adults may be an important contributor to disparities in cardiovascular outcomes.
Although there is growing evidence of the benefits of statins (3-hydroxy-3-methylglutaryl coenzyme A reductase isnhibitors) and aspirin for the primary and secondary prevention of CVD,3,11
previous studies have documented racial/ethnic disparities in their use among various subpopulations in the United States.12-16
However, these prior studies leave several questions unanswered. First, most are nearly a decade old and are not generalizable to the older adult population in the U.S.12-15
This is important because medication use has increased substantially during the last decade and statins and aspirin are among the most commonly used medications among older adults,1
and it is unclear whether previously described disparities in younger populations12,13,15
persist in older adults. Second, considerable efforts have been undertaken during the last decade to address racial/ethnic disparities in health care, and it is unclear what impact, if any, these efforts have had on racial/ethnic gaps in cardiovascular medication use among older adults. Third, the studies examining disparities in statin use,12-14
focus on prescription medications alone, and exclude analysis of over-the-counter medications, including aspirin. The Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone-survey, does provide information on aspirin use. Several studies15,17
used BRFSS to report that blacks and Hispanics 35 years and older in the U.S. were less likely to use aspirin than their white counterparts, but these studies do not examine disparities among respondents at high cardiovascular risk. Finally, most prior studies examining disparities in statin use are derived from clinical audits13
or claims data,14
and measure prescribing practices or prescription acquisition, respectively, rather than actual use.18,19
These data may underestimate racial/ethnic disparities in statin use due to differences in adherence20
and the exclusion of respondents who do not use statins due to lack of access to clinical or pharmacy services. A study based on the National Health Nutrition and Examination Survey (NHANES, for 1999–2004)12
does measure actual medication use and reports that blacks and Hispanics are less likely to use statins than their white counterparts. This NHANES study, however, limits its analyses to patients of 18 years and older with high cholesterol and does not examine racial/ethnic disparities by CVD risk among the oldest age groups.
To update and overcome some of the analytic limitations of prior analyses, we used the National, Social life, Health and Aging Project (NSHAP), a recently completed, nationally representative home-based survey of older adults, to examine racial and ethnic differences in cardiovascular medication use among older adults in the United States at low, moderate, and high risk for CVD. We were also interested in understanding the demographic, socioeconomic, and access to care factors associated with these disparities.