Abstract 35: Age, Gender And Race Bias In Provider Adherence To The 2018 AHA/ACC Cholesterol Guidelines: A Single-Center Retrospective Cohort Analysis

Abstract

Background: Cholesterol treatment is central to cardiovascular risk reduction, but disparities in management may exist. Our hypothesis is that demographic factors may predict guideline adherence. Methods: This retrospective cohort analysis included patients seen at an urban academic medical center between November 2018 to March 2021. Patient and provider demographics, cardiovascular comorbidities, and lab values were examined to determine if provider adherence to the 2018 AHA/ACC cholesterol guidelines demonstrated bias by age, gender, or race. Logistic models were estimated via generalized estimating equations to account for clustering by patient and provider and used to calculate odds ratios (OR), confidence intervals, and p-values. Results: 24,733 lipid panels were obtained from patients with mean age 57.8 ± 15.6, BMI 29.4 ± 6.8, 56.9% female, 44.2% White, 42.1% Black, 6.8% Asian, 6.8% Other, 26.5% tobacco use, 12.7% ASCVD, 51.1% hypertension, 21.1% diabetes. Significant adjusted OR for appropriate treatment was 0.91 (p<0.001) for each 1-year increase in age, 2.2 (p<0.001) for female, 0.88 (p=0.02) for Black relative to White, 1.36 (p=0.003) for Asian relative to White, 0.73 (p<0.001) for BMI>40 relative to BMI<25. Providers had mean age 51.1 ± 12.2, 60.5%female, 73.2% White, 6.9% Black, 18.6% Asian, 1.3% Other. On univariate analysis, OR for appropriate statin prescription were 0.82 (p=0.016) for provider-patient race discordance; 0.90 (p=0.251) for gender discordance, 0.34 (p<0.001) if provider age 10+ years younger than the patient, and 4.72 (p<0.001) if provider age 10+ years older. On multivariate analysis adjusted for clinical risk factors, none of these OR for patient-provider discordance were significantly different from 1: race 1.06 (p=0.42), gender 0.96 (p=0.34), provider 10+ years younger 1.05 (p=0.61), provider 10+ years older 0.91 (p=0.32). Conclusion: In this analysis, Black, male, morbidly obese and older patients were less likely to receive appropriate statin therapy. However, there was no evidence that inappropriate treatment was associated with patient-provider age, gender, or race discordance. Further investigation is needed to guide targeted interventions aimed at addressing these inequities.