ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Racial and Ethnic Disparities in Statin Adherence: Insights from the All of Us Research Program
Provisionally accepted
Gabriela Escobar
Zahra AziziAnne de HondAshley Adanna Lewis
Madelena Y NgFatima Rodriguez
Tina Hernandez-Boussard*- Stanford University, Stanford, California, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Statin adherence impacts cardiovascular outcomes, yet disparities persist. Understanding sociodemographic factors and barriers is crucial for targeted interventions. Objective: To investigate the relationship between sociodemographic factors and statin adherence across racial and ethnic groups. Design: This retrospective study examined sociodemographic factors, prescription records, clinical factors, and responses from the Demographic, Drug Exposure, Healthcare Utilization Survey (HUS) in the All of Us (AoU) cohort. Multivariable logistic regression models assessed the impact of sociodemographic factors on adherence stratified by race. Participants: Adult participants with statin prescription records. Subgroup analyses included those who responded to the HUS. Exposures: Statin prescription Main Outcome(s) and Measure(s): Percent days covered (PDC), calculated as the proportion of days within a year in which a person prescribed a statin filled a prescription. Adequate adherence was defined as PDC ≥ 80%. Results: Among 17,029 adults with a statin prescription, mean percent days covered (PDC) was 57%, and 66% had PDC ≤80%. In multivariable analyses stratified by race and ethnicity, distinct barriers to adherence emerged. Among Non-Hispanic White (NHW) participants, barriers to consistent healthcare (OR=0.60, 95% CI [0.42–0.87]) and lack of provider identity concordance (OR=0.83, 95% CI [0.72–0.97]) were associated with lower adherence. For Non-Hispanic Black (NHB) participants, Medicare (OR=0.54, 95% CI [0.32–0.90]) and VA insurance (OR=0.44, 95% CI [0.20–0.96]), as well as financial barriers (OR=0.69, 95% CI [0.51–0.96]), reduced adherence. Among Hispanic participants, provider-related anxiety (OR=0.13, 95% CI [0.02–0.87]), immigrant status (OR=0.25, 95% CI [0.08–0.72]), and Medicaid coverage (OR=0.11, 95% CI [0.03–0.45]) predicted lower adherence.Of the 17,029 participants with a statin prescription, the mean statin PDC was 57%, with 66% reporting a PDC ≤ 80%. Racial and ethnic differences in adherence were observed, with Non-Hispanic White (NHW) participants having a median PDC of 74% (IQR [0.25,0.98]), Non-Hispanic Black (NHB) 49% (IQR [0.25,0.98]), and Hispanic participants 25% (IQR [0.08,0.49]). NHW participants faced employment barriers (OR 0.63, 95% CI [0.46, 0.86]) and provider inaccessibility (OR 0.56, 95% CI [0.40, 0.76]) as significant factors for lower adherence. NHB participants experienced patient anxiety (OR 0.53, 95% CI [0.30, 0.90]) and financial barriers (OR 0.65, 95% CI [0.50, 0.85]), while Hispanic participants showed
Keywords: statin, adherence, SDOH, race and ethnicity, All of Us cohort
Received: 04 Feb 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Escobar, Azizi, de Hond, Lewis, Ng, Rodriguez and Hernandez-Boussard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tina Hernandez-Boussard
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.