Prevalence of Statin Use and Predictors of Statin Initiation Among Patients with Alcohol-Related Cirrhosis - A Danish Nationwide Cohort Study

Abstract

Purpose

Statins reportedly increase the survival of patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis), but this association might be confounded by socioeconomic status. We examined the prevalence of statin use and socioeconomic and demographic predictors of statin initiation and discontinuation among patients with ALD cirrhosis.

Patients and Methods

Using Danish nationwide healthcare registries, we examined statin use among patients diagnosed with ALD cirrhosis in 1997–2018. We computed the prevalence of statin use and incidence of statin initiation and discontinuation, and we used multivariable Cox regression to identify predictors of statin initiation and discontinuation.

Results

We identified 28,260 patients with ALD cirrhosis in 1997–2018. During this period, the prevalence of statin use rose sharply, reaching 19.0% in late 2018. Among patients diagnosed with ALD cirrhosis after 2010, 16.9% were using statins when they were diagnosed with cirrhosis. Among the patients who did not use statins initially, those with lower educational attainment were more likely to begin taking them than those with higher attainment. Also, cohabiting patients were more likely to begin than patients who lived alone, and employed patients were more likely to begin compared to patients outside the labour force. Among current statin users, unemployment predicted statin discontinuation.

Conclusion

The use of statins has become increasingly prevalent among Danish patients with ALD cirrhosis, reaching 19.0% in 2018. Employment, cohabitation, and a short education predicted statin initiation after ALD cirrhosis diagnosis, and unemployment predicted statin discontinuation. Overall, statin use was not a marker of a high socioeconomic status.

Keywords:

• liver cirrhosis
• alcoholic
• hydroxymethylglutaryl-CoA reductase inhibitors
• anticholesteremic agents
• socioeconomic factors

Abbreviations

ALD cirrhosis, Cirrhosis caused by alcohol-related liver disease; NPR, The Danish National Patient Registry; ICD-10, 10th revision of the International Statistical Classification of Diseases and Related Health Problems; DNPR, The Danish National Prescription Registry; ATC Classification System, Anatomical Therapeutic Chemical Classification System; IQR, Interquartile range; HR, Hazard ratio; CI, Confidence interval.

Data Sharing Statement

This study was conducted using Danish healthcare registries. Access to the data sources for this study is restricted and maintained by Danish health data authorities and only available through an application.

Ethics Approval and Informed Consent

This nationwide registry-based cohort study was conducted in accordance with Danish law. No individual consent was needed because we used pseudonymized data from Danish healthcare registries. We did not have contact with patients or their medical charts, so we did not need permission from an ethics committee to conduct the study.

Disclosure

Ms Marine Sølling Ramsing reports grants from Novo Nordisk Foundation, during the conduct of the study. Dr Peter Jepsen reports grants from Novo Nordisk Foundation, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

PJ was supported by a grant from the Novo Nordisk Foundation (NNF18OC0054612). The funding organization was not involved in the conception, the writing, or the decision to submit the manuscript for publication.