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APHA Scientific Session and Event Listing

Recorded presentation

Lisa Mucha, PhD¹, Tami Mark, PhD¹, and Kirsten Axelsen, MS². (1) Research & Pharmaceutical, Thomson Medstat Inc., 125 Cambridge Park Drive, Cambridge, MA 02140, 617-492-9331, lisa.mucha@thomson.com, (2) Global Market Analytics, Pfizer, Inc., 235 E. 42nd Street, New York, NY 10017

Data and Methods: Data came from the Thomson Medstat Marketscan Medicare and Medicaid claims databases. Medicaid data were from five large states representing approximately 23% of Medicaid beneficiaries nationwide. None of the states had any access restrictions on lipid lowering agents. Beneficiaries who were prescribed lipid lowering agents during 2003 and enrolled for the full year in both Medicaid and Medicare were included in the study sample. Logistic regression models estimated the probability that beneficiaries, by ethnicity, switched to a different lipid lowering medication, augmented with a different agent, or titrated up the dosage of the drug over the course of the year. Switching was defined as a change in the lipid lowering agent prescribed during the year, augmentation was at least 30 days of overlapping therapy, and titration upwards was two consecutive prescriptions with an increase in dosage. Results: There were 102,693 Caucasians, 22,570 African Americans, 32,675 Hispanic, and 81,592 other ethnicity patients in the sample. Fewer African Americans (9%) switched lipid lowering agents than Asians, Hispanics, Caucasians or other ethnicities (14%, 13%, 12%, and 13%, respectively) did. Also, fewer African Americans (3%) augmented with another lipid lowering agent than Asians, Hispanics, Caucasians or other ethnicities (6%, 5%, and 6% 5%, respectively) did. The multivariate logistic regressions showed that African Americans were statistically significantly less likely to switch lipid lowering agents (odds ratio 0.68; 95% CI 0.60-0.78), augment lipid lowering agents (odds ratio 0.53; 95% CI 0.43-0.66), or titrate up (odds ratio 0.75; 95% CI 0.67-0.84) than Caucasians. The models controlled for age, gender, state of residence, days on therapy, number of outpatient visits, and the Chronic Disease Score. Discussion: Results of this study showed lipid lowering agent prescribing for African Americans tended to be less aggressive as evidenced by fewer switches, less augmentation and less upward titration than other ethnicities. This is consistent with the literature showing treatment of hyperlipidemia is less aggressive for African Americans. The lipid lowering agent treatment for African Americans relative to Caucasians in this study may reflect treatment differentials such as a clinician being less likely to increase doses of lipid lowering agents to help these patients reach goal. However, it may also reflect the effectiveness of lipid lowering agents in lowering and keeping patients at a consistently low level. These treatment disparities merit further observation as dual eligibles move into Medicare part D plans with differing coverage levels and formulary restrictions.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Assess treatment differentials in statin use by ethnicity.
• Discuss the reasons for treatment disparities in statin use between African Americanss and other ethnicities.
• Identify potential problems for dual Medicare/Medicaid patients on statins as they move to Medicare Part D.

Keywords: Ethnic Minorities, Cholesterol

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation