To explore the relative strength of associations of region and hospital and patient characteristics with high-intensity statin use after myocardial infarction (MI), a team of researchers, including Drs. Lisandro Colantonio, Paul Muntner, the late Meredith Kilgore, Byron Jaeger, and Emily Levitan from the University of Alabama at Birmingham School of Public Health collaborated in a study to determine what drives this variation.

This retrospective cohort analysis used Medicare administrative claims and enrollment data to evaluate fee-for-service Medicare beneficiaries 66 years or older who were hospitalized for MI from January 1, 2011, through June 30, 2015, with a statin prescription claim within 30 days of discharge. Data were analyzed from January 4, 2017, through May 12, 2019.

Among the 139 643 fee-for-service beneficiaries with a mean age of 76.7 years, high-intensity statin use overall increased from 23.4 percent in 2011 to 55.6 percent in 2015, but treatment gaps persisted across regions. In models considering region and beneficiary and hospital characteristics, region was the strongest correlate of high-intensity statin use, with 66 percent higher use in New England than in the West South Central region. Hospital size of at least 500 beds, medical school affiliation, male sex, and patient receipt of a stent were associated with greater high-intensity statin use. For-profit hospital ownership, patient age older than 75 years, prior coronary disease, and other comorbidities were associated with lower use.

This study’s findings suggest that geographic region is the strongest correlate of high-intensity statin use after MI, leading to large treatment disparities.