Who receives statins? Variations in physicians’ prescribing patterns for patients with coronary heart disease, dyslipidemia, and diabetes

Our objective is to estimate the extent to which clinical and non-clinical factors are associated with physicians’ prescribing patterns for statins. The data are from the National Ambulatory Medical Care Survey for the period 1992 through 2004. The three samples examined included more than 14,000 patients who were diagnosed with coronary heart disease, high cholesterol, or diabetes, individuals who are most likely to benefit from being prescribed a statin drug. Using a multinomial logit framework, we find disparities in prescribing patterns based on non-clinical factors. Namely, whites and patients who have private insurance are more likely to be prescribed a statin than nonwhites and those with public insurance. Also, even though a large increase occurred in the uptake of statins over the period 1992 to 2004, our results for 2004 show that only about 50 percent of patients diagnosed with coronary heart disease were prescribed a statin. Because coronary heart disease is the leading cause of death in the U.S. and currently is estimated to cost over $150 billion annually in the U.S. in direct and indirect costs, observed differences in prescribing patterns along these dimensions is troubling and should be part of discussions dealing with health care reform.