LAUSR

Introduction: Cardiovascular disease (CVD) disproportionately affects racial minorities in the US. Aspirin is recommended for primary prevention in persons at high CVD risk. Prior evidence revealed racial and gender disparities in aspirin use for primary prevention. Objectives: To describe recent trends in aspirin use for primary prevention by race and gender to identify factors associated with differences in aspirin use. Methods: Data from the National Health and Nutrition Examination Surveys, 2011-2018, were analyzed. Participants aged 40-79 years, without prior history of CVD were included. Logistic regression was used to assess the association of aspirin use with comorbidities and sociodemographic factors. Results: Among 11212 participants, 47.0% were men; the mean (SD) age was 55.8 (9.79) years; 33.1% were non-Hispanic Whites (W), 23.7% non-Hispanic Blacks (B), and 13.1% Hispanics (H). Aspirin use was more prevalent among W (37.8%) compared to B (26.5%) and H (11.5%) ( P -value <0.001). Trends in aspirin use varied by race and gender over the eight-year follow-up period (Figure 1). Generally, aspirin use was significantly lower in women than men. There was a downward trend in aspirin use in H and B women; H men and women had the lowest prevalence of use across the follow-up duration. Aspirin use was significantly higher at older age, with higher BMI, more comorbidities, non-smokers, and having insurance. Compared to W, H (but not B) had a persistently lower likelihood of aspirin use over time in the unadjusted logistic regression model. After adjustment, race (but not gender) was no longer significantly associated with aspirin use. Conclusions: Aspirin use for primary prevention remains prevalent among W compared to others and among men compared to women. However, after adjusting for several covariates, the effects of race were removed but the gender differences remained. The persistent gender gap in aspirin use for primary prevention requires further explanation, and for those at high risk, intervention.