262863 Pharmaceutical treatment for community-dwelling Medicare beneficiaries with cardiovascular disease: Influence of dementia status and race/ethnicity

Monday, October 29, 2012 : 12:50 PM - 1:05 PM

Priscilla T. Ryder, MPH PhD , College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
John Mulvaney, MHA , College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, US Virgin Islands
  
     
Racial/ethnic treatment disparities for cardiovascular disease (CVD) have been reported; likewise, people with dementia may receive some medications less often than cognitively intact persons. Little is known about CVD medication disparities in dementia or whether race/ethnicity-dementia status interactions exist for CVD treatment. Using self-report and/or claims diagnoses, 10,204 beneficiaries with CVD were identified in years 2001-2006 of the Medicare Current Beneficiary Survey and associated Medicare claims. Retrospective longitudinal analysis tracked beneficiaries ages 65 years or older. Generalized estimating equation (GEE) analysis calculated odds ratios (ORs) for self-reported use of cardiovascular medications. Mean age was 77.2+7.2; 86.9% self-identified as non-Hispanic white, 8.7% as non-Hispanic black, and 4.4% were classified as ‘other;' 13.2% had dementia. Those with dementia were significantly older, poorer, less educated, and more likely to be non-Hispanic black. Non-Hispanic whites were more often older; male; with more education, income, and prescription coverage than non-Hispanic blacks. OR for treatment for those with dementia = 1.25 (95%CI = 1.15-1.35). In adjusted analysis, dementia status (OR = 1.24; 95%CI = 1.14-1.35), proxy response (OR = 0.61; 95%CI = 0.55-0.66), prescription insurance (OR = 1.25; 95%CI = 1.16-1.36), and year significantly predicted treatment, controlling for race/ethnicity, sex, and income. Race/ethnicity was not significantly associated with treatment in unadjusted or adjusted models. No race-dementia interaction was found. Dementia status, but not race/ethnicity, predicted pharmaceutical treatment for CVD among community-dwelling Medicare beneficiaries. Controlling for age, sex, race/ethnicity, education, prescription insurance, income, diagnosis source, proxy reporting, and year made little change in the OR for treatment of those with dementia.

Learning Areas:
Chronic disease management and prevention
Epidemiology
Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
1. Explain reasons that disparities by race/ethnicity and dementia status would be expected for pharmaceutical treatment of cardiovascula disease. 2. Describe treatment disparities by dementia status in Medicare beneficiaries 3. Evaluate evidence for an interaction between dementia status and race/ehtnicity in this population.

Keywords: Health Care Access, Dementia

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have previously published on medication disparities among Medicare beneficiaries as well as racial/ethnic disparities in service utilization and medication use in people with dementia. I am the public health specialist at a pharmacy school, concentrating in the area of health disparities, especially among mature and older adults.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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