Racial Differences In The Use Of Over-the-counter Non-steroidal Anti-inflammatory Drugs Among Individuals At Risk Of Adverse Cardiovascular Events

Introduction: Over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used despite conferring risk for adverse cardiovascular events (ACEs). ACEs disproportionately affect Black individuals, yet patterns of OTC NSAID and high-potency powder NSAID (HPP-NSAID) use among different racial groups remains understudied. Hypothesis: We hypothesized that use of OTC NSAIDs and HPP-NSAIDs is higher among Black individuals. Methods: We analyzed data from the North Carolina Colon Cancer study, a population-based case-control study in 1996-2000. Participants at risk of ACEs, defined as self-reported hypertension, diabetes, heart disease, or smoking history ≥ 20 years, were included in our analysis. Primary outcomes were any OTC NSAID use and HPP-NSAID use. Secondary outcomes included regular use of the primary outcome variables. Using multivariable logistic regression, we quantified the independent association of the outcomes with race after adjusting for age, sex, education, poverty, and pain interfering with daily activities. We investigated the effect modifications of poverty status and educational attainment separately on the noted associations. Results: Of the 1286 participants at risk for ACEs, 583 (45%) reported Black, 695 (54%) White, and 8 (<1%) Other race. Overall, 665 (52%) reported any NSAID use and 204 (16%) reported HPP-NSAID use. Any NSAID use was reported by 329 (57%) Black participants compared to 332 (48%) White participants. HPP-NSAID use was reported by 126 (22%) Black participants compared to 76 (11%) White participants. Of users, 174 (26%) reported regular NSAID use and 37 (18%) reported regular HPP-NSAID use; this pattern was similar across race. In multivariable analysis, Black (versus White) race was independently associated with higher odds of NSAID use (odds ratio [OR] 1.4 95% confidence interval [1.1, 1.8]). Pain interfering with daily activities (OR 1.4 [1.1, 1.8]) was also associated with NSAID use and older age was negatively associated with NSAID use (OR 0.96 [0.95, 0.97]). After adjustment, Black race was associated with HPP-NSAID use (OR 1.8 [1.3, 2.6]). Male sex (OR 1.6 [1.2, 2.3]) and being in or near poverty (OR 1.6 [1.0, 2.3]) were also independently associated with HPP-NSAID use and older age (OR 0.96 [0.94, 0.97]) and educational attainment of some college or greater (OR 0.5 [0.3, 0.7]) were negatively associated with HPP-NSAID use. The associations between race and either outcome were not significantly moderated by educational attainment nor poverty status. Conclusions: In this population-based study, Black individuals at risk of ACEs had higher odds of any NSAID and HPP-NSAID use than White participants, even after controlling for pain and socio-economic status. Further research is necessary to determine the impact of this differential use on established inequities in cardiovascular outcomes.