Identifying Racial, Ethnic, and Socioeconomic Inequities in the Use of Novel P2Y12 Inhibitors After Percutaneous Coronary Intervention

Background. Novel P2Y(12) inhibitors prasugrel and ticagrelor were approved for patients with acute coronary syndrome (ACS) in 2009 and 2011, respectively. We assessed the association of racial, ethnic, and socioeconomic factors with initiation of and adherence to novel P2Y(12) inhibitors in a commercially insured population. Methods. We performed a retrospective cohort analysis of adults undergoing percutaneous coronary intervention with placement of a drug-eluting stent, stratified by ACS status, between January 2008 and December 2016 using Clinformatics Data Mart (OptumInsight). We estimated multivariable logistic regression models to identify factors associated with the initiation of clopidogrel vs novel P2Y(12) inhibitors as well as subsequent 6-month medication adherence, assessed via pharmacy records. Results. A total of 55,664 patients were included in the analysis. Hispanic ethnicity was independently associated with the initiation of clopidogrel compared with novel P2Y(12) inhibitors among ACS patients (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.04-1.36; P<.01). ACS patients with an annual median household income of over $100,000 were less likely to be started on clopidogrel when compared with those who earned less than $40,000 (OR, 0.67; 95% CI, 0.61-0.75; P<.01). Black race, Hispanic ethnicity, and lower household income were each associated with significantly reduced odds of P2Y(12) inhibitor adherence. Conclusion. Hispanic ethnicity and lower household income were associated with novel P2Y(12) inhibitor initiation, and non-White race and ethnicity were associated with lower P2Y(12) inhibitor adherence over 6-month follow-up. These findings highlight continued inequity of care, even in an insured population, and point to a need for new strategies to close these gaps.

Automated summary

This study assessed the association of racial, ethnic, and socioeconomic factors with the use and adherence to novel P2Y(12) inhibitors in a commercially insured population. The results showed that Hispanic patients were more likely to use clopidogrel instead of novel P2Y(12) inhibitors in comparison to ACS patients. Additionally, Black race, Hispanic ethnicity, and lower household income were associated with reduced adherence to P2Y(12) inhibitors.