URBAN-RURAL DISPARITIES IN THE PRESCRIPTION OF NOVEL LIPID-LOWERING THERAPIES

Therapeutic Area

Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research

Background

Rural areas in the U.S. face a disproportionate burden of atherosclerotic cardiovascular disease (ASCVD) and face limited access to specialist care. Because specialists more commonly prescribe novel therapies, this can also impact access to new medications. In this study, we sought to examine rural-urban differences in the presence and characteristics of prescribers of novel lipid lowering therapies (LLT).

Methods

This cross-sectional study analyzed pharmacy transaction data from Symphony Health Solutions (2018–2022) for all prescriptions of any lipid lowering therapy. Prescribers were identified from the Symphony database and cross-matched with their National Provider Identifier number. Prescriber address was linked to census tract-level data, which were classified as rural or urban based on Health Resources and Services Administration definitions. At the census-tract level, the presence of prescribers for novel LLTs overall and by prescriber specialty was assessed.

Results

Among 85,396 census tracts (20.3% rural), 62.9% had at least one prescriber of LLT, including 66.7% of urban and 59.7% of rural census tracts. Of these with any LLT prescriber, at least one prescriber of novel LLT (PCSK9i or Bempedoic acid) was present in 42.7% of rural census tracks and 36% of urban census tracks. In urban areas, 67.7% of cardiology LLT prescribers and 50.2% of primary care prescribers had prescribed at least one novel LLT. In rural areas, 80.0% of cardiologists and 52.9% of primary care prescribers had prescribed at least one novel LLT. In multivariable modeling, the presence of a cardiologist was associated with greater likelihood of the presence of a prescriber of novel LLT (OR 11.6, 95%CI 10.2–11.6), but there was no difference in the odds of the presence at least one prescriber of novel LLT between urban and rural areas (OR 1.0, 95%CI 0.9–1.0).

Conclusions

Specialists and primary care providers in rural areas were more likely to prescribe a novel LLT than those in urban areas. As a result, despite differences in access to specialist care, among census tracts with at least one prescriber of LLT, rural areas were not less likely to have a prescriber of novel LLT.