Aspirin Compliance for Cardiovascular Disease and Colorectal Cancer Prevention in the Uninsured Population

From the 2019 HVPAA National Conference

Ms. Nina Liu, Mr. Justin Swanson (University of South Florida), Mr. Noura Ayoubi (University of South Florida), Dr. Abu-Sayeef Mirza (University of South Florida), Dr. Rahul Mhaskar (University of South Florida), Dr. Adithya Mathews (University of South Florida)

Background: As an irreversible inhibitor of cyclooxygenase, aspirin is an effective anti-inflammatory and antiplatelet agent. In 2016, the U.S. Preventative Services Task Force (USPSTF) recommended aspirin for primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in patients aged 50 to 69 with a 10% or greater 10-year CVD risk. This is a class B recommendation for 50-59 year-olds and a class C recommendation for 60-69 year-olds. Current guidelines for patients with prior myocardial infarction (MI) or coronary artery disease (CAD) include aspirin use for the secondary prevention of CVD. Due to the lack of literature describing compliance with these recommendations in the uninsured patient population, we studied the aspirin adherence for CVD and CRC prevention in several free medical clinics.

Objective: Determine the rates of aspirin use in the uninsured population and compare to those of the general population.

Methods: This study examined 8857 uninsured patients who visited nine free medical clinics in the Tampa Bay Area in 2016-2017. Of the total patient population, 2724 (30.8%) were aged 50-69 and 306 (3.5%) individuals had a prior MI or CAD. 10-year Framingham risk scores for CAD were calculated for the 50-69 year-old population to evaluate which patients qualified for aspirin usage. Aspirin compliance was assessed for patients with prior MI or CAD.

Results: 1467 (53.9%) patients qualified to take aspirin for primary prevention of CVD and CRC. 16.8% of the patients aged 50-59 were on the medication. 15.5% of the patients aged 60-69 were taking aspirin and significantly more men than women were on aspirin (p=0.025). Of the 306 patients who had prior MI or CAD and qualified to take aspirin for secondary prevention, 50% were on the medication.

Conclusions: Among the uninsured population, there is low compliance with recommendations for aspirin usage to reduce the risk of CVD and CRC. This study demonstrates that further improvements are needed to increase adherence to current guidelines and address barriers uninsured patients may face in maintaining their cardiovascular and colorectal health.

Clinical Implications: Aspirin is used as an inexpensive preventative measure, thus emphasis needs to be placed on educating patients and providers of its value and existing guidelines. Due to its low cost, aspirin is an especially valuable and cost-effective tool to prevent CVD and CRC in the uninsured population.

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