Statin use among uninsured individuals in a charity community clinic

Abstract

Background/Synopsis

Limited data exist on lipid-lowering treatment in vulnerable populations, particularly those receiving primary care at charity community clinics. These clinics serve uninsured individuals with little to no access to healthcare providers, including safety-net healthcare systems.

Objective/Purpose

To assess statin therapy among statin-eligible patients at a primary care charity clinic (North Dallas Shared Ministry, NDSM; Dallas, TX).

Methods

We queried the electronic medical records (Athena Health) at NDSM (2016-2024) to extract demographic data, ICD-10 diagnoses, laboratory values, and statin prescriptions for both children and adults. Patients were categorized into four statin benefit groups per the 2018 AHA/ACA cholesterol guidelines. Multivariate logistic regression was performed to identify factors associated with statin prescriptions.

Results

Among 5,097 children (51% female, 89% Hispanic), 28 had lipids checked. One child had LDL-C ≥ 130 mg/dL, potentially qualifying for statin therapy. Among 34,982 adults (median age 41 years, 61% female, 86% Hispanic), 985 had lipids testing and sufficient data to determine if they belong to a statin benefit group. Statin prescription rates by benefit group were: ASCVD (n=43): 70%; diabetes (n=597): 58%; LDL-C ≥ 190 mg/dL (n=39): 87%; ASCVD risk ≥ 7.5%: 41%. Overall, 54% of statin-eligible patients were prescribed statins. In multivariate analysis, factors associated with statin prescriptions included age (OR 2.6, 95% CI 1.8, 3.6), diabetes diagnosis (OR 6.0, 95% CI 3.2, 11.5), total cholesterol (OR 2.5, 95% CI 2.1, 3.0), and HDL-C (OR 0.7, 95% CI 0.5, 0.7), (p < 0.0001, C-index 0.889).

Conclusions

Among uninsured patients in a primary care, charity community clinic, statin prescription rates were slightly higher than those reported in insured populations (∼50%), with similar predictors of statin prescriptions (e.g., age, diabetes diagnosis, lipid levels). However, lipid screening was infrequent – only 3% of adult patients had lipids checked – suggesting most statin-eligible patients likely remain unidentified. These findings highlight a critical gap: the need to improve lipid screening in uninsured populations to ensure at-risk individuals are identified and treated appropriately. In addition, future analyses should assess not only statin prescription rates but also whether patients receive appropriate statin intensity and non-statin therapies like ezetimibe and PCSK9 inhibitors.