Reversal of Fortune: Income Disparities in Cholesterol Before and After the Era of Statins

Virginia W. Chang, University of Pennsylvania
Diane S. Lauderdale, University of Chicago

Cholesterol levels, a central risk factor for cardiovascular disease, have been significantly altered in recent years by pharmaceutical innovation. Introduced in the late 1980’s, statins (HMG-CoA reductase inhibitors) offered, for the first time, highly effective drug control. In this paper, we examine income disparities in cholesterol before and after the introduction of statins. As an expensive and potent new technology, statins may be disproportionately adopted those who are better resourced, creating or exacerbating social disparities. Using NHANES data from 1976 to 2004, we find that income gradients for both total cholesterol and fasting LDL were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were once more likely to have high levels of cholesterol, they are now less likely to have such unhealthy outcomes. These secular changes serve as forceful example of social conditions as a fundamental cause of disease.