Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease

A cross-sectional study in North America

Joseph A. Ladapo, Adrian Coles, Rowena J. Dolor, Daniel B. Mark, Lawton Cooper, Kerry L. Lee, Jonathan Goldberg, Michael Shapiro, Udo Hoffmann, Pamela S. Douglas

    Research output: Contribution to journalArticle

    Abstract

    Objectives To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk. Design Cross-sectional study assessing potential preventive gaps. Participants 10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD. Setting PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014. Measures Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese. Results Preventive treatment gaps affected 14% of patients with hypertension, 36% of patients with dyslipidaemia and 32% of patients with diabetes. Overall, 49% of patients were sedentary, 18% currently smoked and 48% were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95% CI 1.02 to 1.82). Conclusions Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event. Clinical trial registration Clinical Trials.gov identifier NCT01174550.

    Original languageEnglish (US)
    Article numbere016364
    JournalBMJ Open
    Volume7
    Issue number9
    DOIs
    StatePublished - Sep 1 2017

    Fingerprint

    North America
    Life Style
    Coronary Artery Disease
    Cross-Sectional Studies
    Dyslipidemias
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Therapeutics
    Preventive Medicine
    Primary Care Physicians
    Social Class
    Clinical Trials
    Hypertension
    Geography
    Angiotensin Receptor Antagonists
    Angiotensin-Converting Enzyme Inhibitors
    Smoke
    Sex Characteristics
    Antihypertensive Agents
    Multicenter Studies
    Outpatients

    Keywords

    • cardiac stress testing
    • coronary artery disease
    • coronary computed tomography angiography
    • health disparities
    • socioeconomics

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease : A cross-sectional study in North America. / Ladapo, Joseph A.; Coles, Adrian; Dolor, Rowena J.; Mark, Daniel B.; Cooper, Lawton; Lee, Kerry L.; Goldberg, Jonathan; Shapiro, Michael; Hoffmann, Udo; Douglas, Pamela S.

    In: BMJ Open, Vol. 7, No. 9, e016364, 01.09.2017.

    Research output: Contribution to journalArticle

    Ladapo, Joseph A. ; Coles, Adrian ; Dolor, Rowena J. ; Mark, Daniel B. ; Cooper, Lawton ; Lee, Kerry L. ; Goldberg, Jonathan ; Shapiro, Michael ; Hoffmann, Udo ; Douglas, Pamela S. / Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease : A cross-sectional study in North America. In: BMJ Open. 2017 ; Vol. 7, No. 9.
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    abstract = "Objectives To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk. Design Cross-sectional study assessing potential preventive gaps. Participants 10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD. Setting PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014. Measures Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese. Results Preventive treatment gaps affected 14{\%} of patients with hypertension, 36{\%} of patients with dyslipidaemia and 32{\%} of patients with diabetes. Overall, 49{\%} of patients were sedentary, 18{\%} currently smoked and 48{\%} were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95{\%} CI 1.02 to 1.82). Conclusions Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event. Clinical trial registration Clinical Trials.gov identifier NCT01174550.",
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    author = "Ladapo, {Joseph A.} and Adrian Coles and Dolor, {Rowena J.} and Mark, {Daniel B.} and Lawton Cooper and Lee, {Kerry L.} and Jonathan Goldberg and Michael Shapiro and Udo Hoffmann and Douglas, {Pamela S.}",
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    T1 - Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease

    T2 - A cross-sectional study in North America

    AU - Ladapo, Joseph A.

    AU - Coles, Adrian

    AU - Dolor, Rowena J.

    AU - Mark, Daniel B.

    AU - Cooper, Lawton

    AU - Lee, Kerry L.

    AU - Goldberg, Jonathan

    AU - Shapiro, Michael

    AU - Hoffmann, Udo

    AU - Douglas, Pamela S.

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    N2 - Objectives To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk. Design Cross-sectional study assessing potential preventive gaps. Participants 10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD. Setting PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014. Measures Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese. Results Preventive treatment gaps affected 14% of patients with hypertension, 36% of patients with dyslipidaemia and 32% of patients with diabetes. Overall, 49% of patients were sedentary, 18% currently smoked and 48% were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95% CI 1.02 to 1.82). Conclusions Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event. Clinical trial registration Clinical Trials.gov identifier NCT01174550.

    AB - Objectives To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk. Design Cross-sectional study assessing potential preventive gaps. Participants 10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD. Setting PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014. Measures Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese. Results Preventive treatment gaps affected 14% of patients with hypertension, 36% of patients with dyslipidaemia and 32% of patients with diabetes. Overall, 49% of patients were sedentary, 18% currently smoked and 48% were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95% CI 1.02 to 1.82). Conclusions Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event. Clinical trial registration Clinical Trials.gov identifier NCT01174550.

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    KW - coronary artery disease

    KW - coronary computed tomography angiography

    KW - health disparities

    KW - socioeconomics

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