Figure 3. A Sequential Modeling Approach for Racial Differences in Statin Undertreatment of African Americans.

The relative risk of statin undertreatment of African American patients are presented here, both unadjusted and with sequential adjustment for relevant confounders. Statin undertreatment was defined as less than ACC/AHA guideline-recommended statin therapy. The following sequential models were created to evaluate how the relative risk of African American race for statin undertreatment:1) Model 1 adjusted for race alone; 2) Model 2 includes age and sex; 3) Model 3 adds clinical characteristics including prior ASCVD (grouped into coronary heart disease, cerebrovascular disease, and other ASCVD), diabetes, obesity, smoking, and hypertension; 4) Model 4 adds socioeconomic factors such as yearly income, insurance status, education level, and numeracy score; 5) Model 5 adds in patient beliefs and perceptions including worry about heart disease, clinician trust, beliefs about statin safety and effectiveness, and beliefs about high cholesterol and heart attack risk; 6) Model 6 adds provider factors including provider type (cardiologist vs. non-cardiologist), whether the patient’s provider reported using the 2013 ACC/AHA guideline as their primary resource for lipid management in the provider survey, and clinic setting (urban vs. rural).

Abbreviations: ACC, American College of Cardiology; AHA, American Heart Association; CI, confidence interval; OR, odds ratio; SES, socioeconomic status