Master's Student University of British Columbia Vancouver, British Columbia, Canada
Background: Familial Hypercholesterolemia (FH) is the most common genetic disorder resulting in elevated LDL cholesterol and premature cardiovascular disease, affecting approximately 1 in 250 individuals. Despite the estimated prevalence and elevated risk associated with FH, the rates of screening, diagnosis, and treatment of FH and other genetic dyslipidemias in children in British Columbia is not known. Our study aimed to use a provincial data set to determine the rates of screening, diagnosis, and medical treatment of pediatric dyslipidemias in British Columbia.
METHODS AND RESULTS: This population-based secular study used data from Population Data BC, a repository of publicly funded health care and demographic information. The cohort included all children aged 0 to < 18 years who were registered with the Medical Services Plan (MSP) for at least one year between January 1, 2000, and December 31, 2021. Children were linked to physician fee-for-service billing data, allowing identification of those who underwent cholesterol testing and those diagnosed with dyslipidemia, using ICD-9 codes. Demographic information, including age, sex, and geographic health authority and urban vs. rural status, was collected from linked datasets (consolidation files). Children who underwent full lipid profiling (identified by specific MSP fee codes) were considered screened. Dyslipidemia diagnoses were based on ICD-9 codes (272-272.9), and statin use was assessed through PharmaNet records. Statistical analysis involved descriptive statistics to summarize trends and bivariate analyses (Chi-squared or Fisher’s exact tests) for categorical variables. Analyses were conducted using R (v.3.6.2).
Of the 2,421,340 children in BC, 109,600 (4.5%) underwent lipid testing between 2000-2021. Screening was more common in males than females (55.4% vs. 44.6%, p < 0.001). Children in urban areas were screened more frequently than those in rural regions, with screening rates of 6.2% and 4.2%, respectively (p < 0.001). Of those screened, 543 (0.5%) were diagnosed with a genetic dyslipidemia, with no sex difference in diagnosis rates. Statin treatment was prescribed to 9.4% (51 children) of those diagnosed, with Atorvastatin and Rosuvastatin being the most commonly dispensed medications. Statin use did not differ significantly by sex (p = 0.276).
Conclusion: This study highlights substantial gaps in dyslipidemia screening and treatment in BC. Only 4.5% of children were screened, and among those diagnosed, less than 10% received statin therapy. These findings underscore the need for enhanced screening and treatment strategies to reduce the risk of premature cardiovascular disease in children.
