Health Disparities in Cholesterol Screening Among Older Americans: Longitudinal Analysis of the Health and Retirement Study (2008-2018)

Introduction: Hypercholesterolemia is often asymptomatic and requires cholesterol screening to be identified. Current guidelines recommend adults at low risk for cardiovascular disease (CVD) to receive cholesterol screening at least every 5 years with more frequent screenings in older adults and/or at higher CVD risk. Yet, currently, about 25% of Americans do not meet the every-5-year screening recommendations. While disparities in the prevention and treatment of hypercholesterolemia continue to rise, little is known regarding factors influencing cholesterol screening among older Americans in the past 10 years. Methods: This longitudinal analysis used data from the Health and Retirement Study (HRS). HRS is a nationally representative survey of older adults in the U.S. The current study focused on data collected from 2008 (Wave 9) to 2018 (Wave 14). Participants who passed away by 2019, ever had CVD or stroke, were under age 55 at baseline, had more than 3 waves of missing data in self-reported cholesterol screening, or any missing data in covariates were excluded from the current analysis. In total, 7643 participants were included. Meeting cholesterol screening recommendations was defined as those reporting more than two cholesterol screenings between waves 9-14. Poisson regression and logistic regression were used for data analysis. Results: Compared to Black, Indigenous, and People of Color (BIPOC), White older Americans were more likely to meet cholesterol screening recommendations (odds ratio= 1.60; p<0.001) and reported a higher frequency of cholesterol screening (incidence rate ratio=1.06; p<0.001). The racial differences remained significant after the adjustment of covariates. Non-smokers (p<0.001), females (p=0.022), having private insurance (p<0.001), higher education (p<0.001), higher BMI (p=0.003), having diabetes (p<0.001), and having hypertension (p<0.001) were associated with a higher likelihood of meeting cholesterol screening recommendations. Conclusions: Important disparities in cholesterol screening were identified among racial minorities, smokers, individuals without private insurance, or with lower educational attainment, highlighting important barriers to address in cardiovascular preventive care.