Using healthcare claims data to identify health disparities for individuals with familial hypercholesterolemia.

Abstract

Background: Intensive lipid-lowering therapy is crucial for individuals with familial hypercholesterolemia (FH) to reach target low-density lipoprotein cholesterol (LDL-C) levels. However, there are limited data on disparities in therapy use among FH patients in the US.

Methods: An epidemiologic analysis of a US healthcare claims database (2016-2020) covering 324 million individuals. Inclusion criteria for this study comprised of individuals with a diagnosis of FH, defined by an ICD-10 diagnosis code of E.78.01. The G-computation approach based on multiple logistic regression models was used to estimate the marginal effects of demographic and socioeconomic variables on prescriptions for high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i).

Results: In the FH cohort (n = 85,457), 45.9% were female, 79.4% identified as White, 12.2% as Black, and 8.4% as Hispanic. Males were more likely to be prescribed high-intensity statins than females: risk difference (RD) [95% CI] = 0.091 [0.086, 0.096]; odds ratio (OR) [95% CI] = 2.03 [1.95, 2.11]. White individuals were more likely to get ezetimibe, PCSK9i, or combination therapy compared to Black individuals (RDs: 0.006-0.041; ORs: 1.22-1.32). Higher income was associated with increased odds of receiving these treatments (RDs: 0.005-0.060 and ORs: 1.17-1.58 for incomes >$50,000). Higher education was linked to a higher likelihood of receiving these treatments (RDs: 0.004-0.038 and ORs: 1.06-1.49 for education levels of some college and higher).

Conclusion: These findings highlight significant disparities, with more intensive lipid-lowering therapies prescribed to White, higher-income, and better-educated individuals. This underscores the need for equitable cardiovascular risk reduction strategies for all FH patients.