PDF(Pubmed)
Abstract：
Type 2 diabetes is 2-3 times more prevalent in people of South Asian and African/African Caribbean ethnicity than people of European ethnicity living in the UK. The former 2 groups also experience excess atherosclerotic cardiovascular disease (ASCVD) complications of diabetes. We aimed to study ethnic differences in statin initiation, a cornerstone of ASCVD primary prevention, for people with type 2 diabetes.
Observational cohort study of UK primary care records, from 1 January 2006 to 30 June 2019. Data were studied from 27,511 (88%) people of European ethnicity, 2,386 (8%) people of South Asian ethnicity, and 1,142 (4%) people of African/African Caribbean ethnicity with incident type 2 diabetes, no previous ASCVD, and statin use indicated by guidelines. Statin initiation rates were contrasted by ethnicity, and the number of ASCVD events that could be prevented by equalising prescribing rates across ethnic groups was estimated. Median time to statin initiation was 79, 109, and 84 days for people of European, South Asian, and African/African Caribbean ethnicity, respectively. People of African/African Caribbean ethnicity were a third less likely to receive guideline-indicated statins than European people (n/N [%]: 605/1,142 [53%] and 18,803/27,511 [68%], respectively; age- and gender-adjusted HR 0.67 [95% CI 0.60 to 0.76], p < 0.001). The HR attenuated marginally in a model adjusting for total cholesterol/high-density lipoprotein cholesterol ratio (0.77 [95% CI 0.69 to 0.85], p < 0.001), with no further diminution when deprivation, ASCVD risk factors, comorbidity, polypharmacy, and healthcare usage were accounted for (fully adjusted HR 0.76 [95% CI 0.68, 0.85], p < 0.001). People of South Asian ethnicity were 10% less likely to receive a statin than European people (1,489/2,386 [62%] and 18,803/27,511 [68%], respectively; fully adjusted HR 0.91 [95% CI 0.85 to 0.98], p = 0.008, adjusting for all covariates). We estimated that up to 12,600 ASCVD events could be prevented over the lifetimes of people currently affected by type 2 diabetes in the UK by equalising statin prescribing across ethnic groups. Limitations included incompleteness of recording of routinely collected data.
In this study we observed that people of African/African Caribbean ethnicity with type 2 diabetes were substantially less likely, and people of South Asian ethnicity marginally less likely, to receive guideline-indicated statins than people of European ethnicity, even after accounting for sociodemographics, healthcare usage, ASCVD risk factors, and comorbidity. Underuse of statins in people of African/African Caribbean or South Asian ethnicity with type 2 diabetes is a missed opportunity to prevent cardiovascular events.
Observational cohort study of UK primary care records, from 1 January 2006 to 30 June 2019. Data were studied from 27,511 (88%) people of European ethnicity, 2,386 (8%) people of South Asian ethnicity, and 1,142 (4%) people of African/African Caribbean ethnicity with incident type 2 diabetes, no previous ASCVD, and statin use indicated by guidelines. Statin initiation rates were contrasted by ethnicity, and the number of ASCVD events that could be prevented by equalising prescribing rates across ethnic groups was estimated. Median time to statin initiation was 79, 109, and 84 days for people of European, South Asian, and African/African Caribbean ethnicity, respectively. People of African/African Caribbean ethnicity were a third less likely to receive guideline-indicated statins than European people (n/N [%]: 605/1,142 [53%] and 18,803/27,511 [68%], respectively; age- and gender-adjusted HR 0.67 [95% CI 0.60 to 0.76], p < 0.001). The HR attenuated marginally in a model adjusting for total cholesterol/high-density lipoprotein cholesterol ratio (0.77 [95% CI 0.69 to 0.85], p < 0.001), with no further diminution when deprivation, ASCVD risk factors, comorbidity, polypharmacy, and healthcare usage were accounted for (fully adjusted HR 0.76 [95% CI 0.68, 0.85], p < 0.001). People of South Asian ethnicity were 10% less likely to receive a statin than European people (1,489/2,386 [62%] and 18,803/27,511 [68%], respectively; fully adjusted HR 0.91 [95% CI 0.85 to 0.98], p = 0.008, adjusting for all covariates). We estimated that up to 12,600 ASCVD events could be prevented over the lifetimes of people currently affected by type 2 diabetes in the UK by equalising statin prescribing across ethnic groups. Limitations included incompleteness of recording of routinely collected data.
In this study we observed that people of African/African Caribbean ethnicity with type 2 diabetes were substantially less likely, and people of South Asian ethnicity marginally less likely, to receive guideline-indicated statins than people of European ethnicity, even after accounting for sociodemographics, healthcare usage, ASCVD risk factors, and comorbidity. Underuse of statins in people of African/African Caribbean or South Asian ethnicity with type 2 diabetes is a missed opportunity to prevent cardiovascular events.
摘要：
2型糖尿病在南亚和非洲/非洲加勒比种族人群中的患病率是居住在英国的欧洲种族人群的2-3倍。前2组还经历了糖尿病的过量动脉粥样硬化性心血管疾病(ASCVD)并发症。我们的目的是研究他汀类药物起始的种族差异，ASCVD一级预防的基石，2型糖尿病患者。
英国初级保健记录的观察性队列研究，从2006年1月1日至2019年6月30日。数据来自27,511（88％）欧洲种族的人，2,386（8％）南亚种族的人，以及1,142名（4%）非洲/非洲加勒比族2型糖尿病患者，没有以前的ASCVD，和指南指出的他汀类药物使用。他汀类药物起始率与种族不同，并估算了可以通过均衡各族裔的处方率而预防的ASCVD事件的数量.欧洲人开始他汀类药物的中位时间为79、109和84天，南亚,和非洲/非洲加勒比种族，分别。与欧洲人相比，非洲/非洲加勒比种族的人接受指南指示的他汀类药物的可能性低三分之一（n/N[％]：605/1,142[53％]和18,803/27,511[68％]，年龄和性别调整后的HR分别为0.67[95%CI0.60至0.76]，p<0.001)。在调整总胆固醇/高密度脂蛋白胆固醇比率的模型中，HR略有减弱（0.77[95％CI0.69至0.85]，p<0.001)，剥夺时没有进一步减少，ASCVD危险因素,合并症，多药，和医疗保健使用情况都占了(完全调整后的HR0.76[95%CI0.68，0.85]，p<0.001)。南亚种族的人接受他汀类药物的可能性比欧洲人低10％（1,489/2,386[62％]和18,803/27,511[68％]，分别为；完全调整后的HR0.91[95%CI0.85至0.98]，p=0.008，对所有协变量进行调整)。我们估计，在英国目前受2型糖尿病影响的人的一生中，通过均衡不同种族的他汀类药物处方，可以预防多达12,600例ASCVD事件。局限性包括常规收集数据的记录不完整。
在这项研究中，我们观察到非洲/非洲加勒比种族的人患有2型糖尿病的可能性大大降低，南亚种族的人不太可能，比欧洲种族的人接受指南指示的他汀类药物，即使考虑到社会人口统计学，医疗保健使用，ASCVD危险因素,和合并症。在患有2型糖尿病的非洲/非洲加勒比或南亚种族人群中，他汀类药物的使用不足是预防心血管事件的错失机会。
英国初级保健记录的观察性队列研究，从2006年1月1日至2019年6月30日。数据来自27,511（88％）欧洲种族的人，2,386（8％）南亚种族的人，以及1,142名（4%）非洲/非洲加勒比族2型糖尿病患者，没有以前的ASCVD，和指南指出的他汀类药物使用。他汀类药物起始率与种族不同，并估算了可以通过均衡各族裔的处方率而预防的ASCVD事件的数量.欧洲人开始他汀类药物的中位时间为79、109和84天，南亚,和非洲/非洲加勒比种族，分别。与欧洲人相比，非洲/非洲加勒比种族的人接受指南指示的他汀类药物的可能性低三分之一（n/N[％]：605/1,142[53％]和18,803/27,511[68％]，年龄和性别调整后的HR分别为0.67[95%CI0.60至0.76]，p<0.001)。在调整总胆固醇/高密度脂蛋白胆固醇比率的模型中，HR略有减弱（0.77[95％CI0.69至0.85]，p<0.001)，剥夺时没有进一步减少，ASCVD危险因素,合并症，多药，和医疗保健使用情况都占了(完全调整后的HR0.76[95%CI0.68，0.85]，p<0.001)。南亚种族的人接受他汀类药物的可能性比欧洲人低10％（1,489/2,386[62％]和18,803/27,511[68％]，分别为；完全调整后的HR0.91[95%CI0.85至0.98]，p=0.008，对所有协变量进行调整)。我们估计，在英国目前受2型糖尿病影响的人的一生中，通过均衡不同种族的他汀类药物处方，可以预防多达12,600例ASCVD事件。局限性包括常规收集数据的记录不完整。
在这项研究中，我们观察到非洲/非洲加勒比种族的人患有2型糖尿病的可能性大大降低，南亚种族的人不太可能，比欧洲种族的人接受指南指示的他汀类药物，即使考虑到社会人口统计学，医疗保健使用，ASCVD危险因素,和合并症。在患有2型糖尿病的非洲/非洲加勒比或南亚种族人群中，他汀类药物的使用不足是预防心血管事件的错失机会。
