Geographic and sociodemographic disparities in aspirin use as a secondary prevention for MI and stroke were observed among patients with preexisting atherosclerotic CVD, according to a recent CDC report.
“The use of this low-cost, effective and generally safe intervention among persons who have existing atherosclerotic [CVD] is supported by multiple evidence-based guidelines, and current data suggest that there is room for increased use in this population,” Jing Fang, MD, from the division for heart disease and stroke prevention at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote in the Morbidity and Mortality Weekly Report.
Fang and colleagues collected data on aspirin prevalence from the 2013 Behavioral Risk Factor Surveillance System, an annual telephone survey supported by the CDC. The analysis included 17,984 respondents with atherosclerotic CVD (ASCVD) from 20 U.S. states and the District of Columbia. The median state response rate was 44%, ranging from 39% to 59%.
The responses were stratified by age, sex, race/ethnicity, education and selected ASCVD risk factors including hypertension, diabetes, high cholesterol and smoking status. According to the results, 70.8% (95% CI, 69.4-72.1) of participants reported using aspirin every day or every other day: of those, 93.6% (95% CI, 92.7-94.5) used aspirin for MI prevention, 79.6% (78.1-81.1) for stroke prevention and 76.2% (74.6-77.8) for both. In addition, 14.9% (95% CI, 13.8-16.0) of participants also used aspirin for pain relief and 4.2% (95% CI, 3.5-4.9) used aspirin exclusively for pain relief.
Regular aspirin use was higher in participants:
- aged 65 years or older (75.0%; CI 95%, 73.5-76.5) vs. 18 to 64 years (65.9%; 95% CI, 63.5-68.2);
- men (76.2%; 95% CI, 74.4-77.9) vs. women (64.4%; 95% CI, 62.3-66.3);
- white adults (73.6%; 95%CI, 72.2-74.9) vs. Hispanic adults (55.6%; 95% CI, 45.7-65.1) and black adults (63.0%; 95% CI, 58.2-67.6);
- those with a college degree (76.7%; 95% CI, 74.2-79.0) vs. less than a high school diploma (65.0%; 95% CI, 61.1-68.7); and
- those with two (74.5%; 95% CI, 72.3-76.5) or more ASCVD risk factors vs. those with only one (63.4%; 95% CI, 60.3-66.4) or no risk factors (54.7%; 95% CI, 49.4-59.9).
Aspirin use for MI prevention was highest in participants:
- aged 65 years or older (94.2%; 95% CI, 93.1-95.1)
- men (95.0%; 95% CI, 93.9-95.9); and
- white adults (94.3%; 95% CI, 93.4-95.1).
Conversely, aspirin use for stroke prevention was highest in participants:
- aged 18 to 64 years (80.8%; 95% CI, 78.3-83.1);
- women (81.2%; 95% CI, 79.2-83.0); and
- black adults (81.5%; 95% CI, 76.6-85.6) and those of other races/ethnicities (81.6%; 95% CI, 75.0-86.7).
The use of aspirin to prevent both MI and stroke was highest in participants aged 65 years or older (75.4%; 95% CI, 73.4-77.4) and those with at least four CV risk factors (83.4%; 95% CI, 77.5-88.0).
Compared with other race/ethnic populations, Hispanic adults reported the lowest total aspirin use overall and for MI (83.3%; 95% CI, 70.7-91.2), stroke (71.8%; 95% CI, 55.4-83.9) and both MI and stroke prevention (61.9%; 95% CI, 46.5-76.3).
A nonsignificant difference in aspirin use was observed throughout most states, ranging from 44.3% (95% CI, 35.3-53.6) in Missouri to 71.7% (95% CI, 59.9-81.0) in Mississippi. The researchers noted that confidence intervals were wide because of the small number of respondents with CHD or stroke.
Possible disparities among other risk groups warrant further research, the researchers wrote. They concluded that interventions targeting patients aged younger than 65 years, women and black and Hispanic adults could reduce the disparities of regular aspirin use. – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.