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National Trends in Statin Use among the United States Nursing Home Population (2011–2016)

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Abstract

Background

Little is known about trends in statin use in United States (US) nursing homes.

Objectives

The aim of this study was to describe national trends in statin use in nursing homes and evaluate the impact of the introduction of generic statins, safety warnings, and guideline recommendations on statin use.

Methods

This study employed a repeated cross-sectional prevalence design to evaluate monthly statin use in long-stay US nursing home residents enrolled in Medicare fee-for-service using the Minimum Data Set 3.0 and Medicare Part D claims between April 2011 and December 2016. Stratified by age (65–75 years, ≥ 76 years), analyses estimated trends and level changes with 95% confidence intervals (CI) following statin-related events (the availability of generic statins, American Heart Association/American College of Cardiology guideline updates, and US FDA safety warnings) through segmented regression models corrected for autocorrelation.

Results

Statin use increased from April 2011 to December 2016 (65–75 years: 38.6–43.3%; ≥ 76 years: 26.5% to 30.0%), as did high-intensity statin use (65–75 years: 4.8–9.5%; ≥ 76 years: 2.3–4.5%). The introduction of generic statins yielded little impact on the prevalence of statins in nursing home residents. Positive trend changes in high-intensity statin use occurred following national guideline updates in December 2011 (65–75 years: β = 0.16, 95% CI 0.09–0.22; ≥ 76 years: β = 0.09, 95% CI 0.06–0.12) and November 2013 (65–75 years: β = 0.11, 95% CI 0.09–0.13; ≥ 76 years: β = 0.04, 95% CI 0.03–0.05). There were negative trend changes for any statin use concurrent with FDA statin safety warnings in March 2012 among both age groups (65–75 years: β trend change = − 0.06, 95% CI − 0.10 to − 0.02; ≥ 76 years: β trend change = − 0.05, 95% CI − 0.08 to − 0.01). The publication of the results of a statin deprescribing trial yielded a decrease in any statin use among the ≥ 76 years age group (β level change = − 0.25, 95% CI − 0.48 to − 0.09; β trend change = − 0.03, 95% CI − 0.04 to − 0.01), with both age groups observing a positive trend change with high-intensity statins (65–75 years: β = 0.11, 95% CI 0.02–0.21; ≥ 76 years: β = 0.05, 95% CI 0.01–0.09).

Conclusion

Overall, statin use in US nursing homes increased from 2011 to 2016. Guidelines and statin-related events appeared to impact use in the nursing home setting. As such, statin guidelines and messaging should provide special consideration for nursing home populations, who may have more risk than benefit from statin pharmacotherapy.

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Acknowledgements

The authors thank Robert Goldberg, PhD, for his guidance with this manuscript. The work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (TL1 TR001454) and the Agency for Healthcare Research and Quality (R36 HS026840). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Author information

Authors and Affiliations

  1. Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, 01605, MA, USA

    Deborah S. Mack, Jennifer Tjia & Kate L. Lapane

  2. Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Deborah S. Mack

  3. Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA

    Anne L. Hume

Authors
  1. Deborah S. Mack
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Corresponding author

Correspondence to Kate L. Lapane.

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Funding

This work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (TL1 TR001454, Principal Investigator [PI]: Lapane; K24AG068300, PI: Jennifer Tjia), and the Agency for Healthcare Research and Quality (R36 HS026840, PI: Mack). This project was supported by grant number R36 HS026840 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Conflicts of interest

Jennifer Tjia is a consultant for CVS Health and Omnicare Long Term Care Pharmacy. Deborah Mack, Anne L. Hume, and Kate L. Lapane have declared no conflicts of interest for this article.

Ethical approval

This study used a routinely collected administrative and claims dataset and was approved by the University of Massachusetts Medical School Institutional Review Board (protocol number H00016995).

Availability of data and material

The authors are unable to share the data used to conduct this study per their Data Use Agreement with the Centers for Medicare and Medicaid Services via RESDAC.

Code availability

The SAS code will be made available on request to the authors.

Author contributions

DM and KLL had full access to all data in the study and are responsible for the data integrity and accuracy of the data analysis. Study concept and design: DM, AH, JT, and KLL. Acquisition of data: KLL. Analysis and interpretation of data: DM, AH, JT, and KLL. Statistical analysis: DM and KLL. Preparation of the manuscript: DM and KLL. Critical revision of the manuscript for important intellectual content: DM, AH, JT, and KLL. Obtained funding: DM. Study supervision: KLL. The final manuscript submitted for publication was read and approved by all authors.

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Mack, D.S., Hume, A.L., Tjia, J. et al. National Trends in Statin Use among the United States Nursing Home Population (2011–2016). Drugs Aging 38, 427–439 (2021). https://doi.org/10.1007/s40266-021-00844-8

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  • DOI: https://doi.org/10.1007/s40266-021-00844-8

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