Abstract 12665: Using Healthcare Claims Data and Machine Learning to Identify Health Disparities for Individuals With Diagnosed and Undiagnosed Familial Hypercholesterolemia

Abstract

Introduction: Individuals with Familial Hypercholesterolemia (FH) warrant intensive lipid lowering therapy starting with statins and adding ezetimibe and PCSK9 inhibitors (PCSK9i) as needed to achieve LDL-C treatment targets. Little data exists on whether disparities exist in the US FH population for ezetimibe, PCSK9i or the combination of statins + ezetimibe + PCSK9i. Methods: We queried the Family Heart Database, a healthcare claims database from the Family Heart Foundation, for filled prescriptions for statins, ezetimibe, and PCSK9i in patients with an ICD-10 diagnosis of FH (E.78.01) as well as undiagnosed FH patients (Probable FH) identified by the Family Heart Foundation’s FIND-FH® machine learning algorithm. Data were analyzed in multivariable models including age, education, income, race/ethnicity, and gender. Results: Among 77,671,959 individuals, 280,426 had an ICD-10 diagnosis of FH (51% female, 79.5% White, 11.8% Black, and 8.7% Hispanic) and 899,027 had Probable FH (48% female, 78.7% White, 12.9% Black, and 8.5% Hispanic). Diagnosed and Probable FH males were 46% and 48% more likely, respectively, than females to receive high intensity statins. Individuals in the $100,000+ income bracket - both the diagnosed and Probable FH groups - were 30 to 50% more likely to receive ezetimibe, PCSK9i, or statin + ezetimibe + PCSK9i (Table). The highest education level was associated with 51% higher odds of statin + ezetimibe + PCSK9i use in diagnosed FH patients. Whites were 6-30% more likely to get ezetimibe, PCSK9i, and the combination of statin + ezetimibe + PCSK9i compared to Blacks. Conclusions: Real world patterns of medical care reveal appropriate lipid lowering therapy is more often prescribed for individuals with FH who are White, have high income, or have advanced education. Efforts are warranted to improve equity and provide all individuals with FH an opportunity for cardiovascular risk reduction.