Socioeconomic Disparities in Dyslipidemia and Associated Complications: From the Latest National Database

Abstract

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Socioeconomic status (SES) reflected by patients' ZIP code may detrimentally influence a healthcare access, education level and dietary options which affect the development of dyslipidemia (DL) and associated complications. There has been a lack of updated data on socioeconomic disparities in dyslipidemia and hospital complications. Objective/Purpose To identify the effects of socioeconomic status on dyslipidemia and its complications. Methods We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Patients with DL were selected using the ICD-10 diagnosis. SES was evaluated using median household income of patients' ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchical regression analysis was performed to calculate Odds Ratio (OR). Results During the study period, 90,856,281 patients were hospitalized of which 27,529,453 patients (30.3%) had DL. 30.4% were from the lowest (1st) quartile followed by 26.4%, 23.4% and 19.6% in ascending order of quartile. The prevalence of DL increased in ascending order of quartile (28.5% vs 30.5% vs 31.2% vs 32.0%). Obesity (17.6% vs 14.3% of 4th quartile) and diabetes (29.8% vs 21.8% of 4th quartile) were the most prevalent in the lowest quartile. After adjusting for age, sex, race, and comorbidity burden, the highest quartile was associated with elevated risk of DL compared the lowest quartile (OR 1.1; 1.1-1.1; p < 0.001). Among those who developed DL, the lowest quartile was at the highest risk for coronary heart diseases (OR 1.2; 1.2- 1.2; p < 0.001) and peripheral artery diseases (OR 1.3; 1.2-1.3; p < 0.001). There is no significant difference in the rate of an ischemic stroke by SES (p = 0.79), but the highest quartile was associated with higher risk for a hemorrhagic stroke (OR 1.3; 1.2-1.3; p < 0.001). Conclusions The prevalence of DL increased with higher SES even with lower proportion of obesity and diabetes. However, the associated complications including coronary heart diseases and peripheral artery disease increased in the lowest SES except hemorrhagic strokes. It may reflect the different healthcare utilization pattern by SES and warrants further study and public intervention to improve DL associated complications in patients from low SES.+++++ Nothing to disclose.