Discontinuation of statins by patient and physician sex: An observational study

Abstract

Background

This observational study using the national US Medicare claim databases aimed to examine the association of patient and physician sex with statin discontinuation.

Methods

We used data on a 20% random sample of Medicare fee-for-service beneficiaries aged 66–99 years who initiated statins for primary prevention (absence of the historical diagnosis of myocardial infarction, ischemic heart disease, stroke, transient ischemic attack, and peripheral vascular disease) from January 2017 to June 2019. The primary outcome was early discontinuation (defined as the lack of second dispense at year 1), adjusting for patient demographics, comorbidities, concomitant medications, and physicians' age and specialty.

Results

Of 423,404 patients who initiated statins, 43,053 (10.2%) experienced early discontinuations. The adjusted risk of early discontinuation was similar but slightly lower when initiated by female physicians at 9.9% [95% confidence interval (CI), 9.1 to 10.6] versus male physicians at 10.3% (95% CI, 9.6 to 11.0) with an adjusted risk difference (aRD) of −0.4 percentage-points (pp) (95% CI, −0.7 to −0.2; p < 0.001). When stratified by patient sex, the findings were similar in both female patients (aRD, −0.5 pp.; 95% CI, −0.7 to −0.2; p < 0.001) and male patients (−0.5 pp.; 95% CI, −0.8 to −0.1; p = 0.007). The findings were consistent regardless of the diabetes status or the intensity of statins.

Conclusion

Using the nationwide administrative databases, we found that both older female and male patients were slightly less likely to experience early discontinuation of statins when prescribed by female versus male physicians, though the differences were clinically small.