Racial and Ethnic Disparities in Alzheimer's Disease Pharmacotherapy Exposure: An Analysis Across Four State Medicaid Populations

Adrienne M. Gilligan MSc, Daniel C. Malone PhD, RPh, Terri L. Warholak PhD, RPh, Edward P. Armstrong PharmD
{"title":"Racial and Ethnic Disparities in Alzheimer's Disease Pharmacotherapy Exposure: An Analysis Across Four State Medicaid Populations","authors":"Adrienne M. Gilligan MSc,&nbsp;Daniel C. Malone PhD, RPh,&nbsp;Terri L. Warholak PhD, RPh,&nbsp;Edward P. Armstrong PharmD","doi":"10.1016/j.amjopharm.2012.09.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span><span>Treatment </span>disparities in </span>Alzheimer's disease (AD) have received little attention. Determining whether disparities exist in this subpopulation is an important health policy issue.</p></div><div><h3>Objective</h3><p>The aim was to determine whether an association existed between race/ethnicity and exposure to AD pharmacotherapy across 4 state Medicaid populations.</p></div><div><h3>Methods</h3><p><span>Data from the Centers for Medicare and Medicaid Services (CMS) were used in this retrospective study. Persons with AD enrolled in California, Florida, New Jersey, or New York Medicaid programs on January 1, 2004, and remained in that program for 1 year. Individuals had an AD diagnosis based on the ICD-9-CM code 331.0. Outcomes of interest were exposure to a </span>cholinesterase inhibitor<span><span> (ChEI) or memantine. Multivariate </span>logistic regression was used to test for the association between race/ethnicity and exposure to a ChEI or memantine. Variables of interest included demographic characteristics and resource utilization factors. The Oaxaca-Blinder decomposition method was used to test for disparities to determine whether exposure to AD pharmacotherapy was influenced by race.</span></p></div><div><h3>Results</h3><p>Race, age, long-term care admittance, inpatient care admittance, state of residence, and sex were significant predictors of AD pharmacotherapy exposure (<em>P</em> &lt; 0.0001 for all variables). Racial/ethnic disparities were observed with respect to exposure to a ChEI or memantine between non-Hispanic whites and Hispanics (in favor of Hispanics) in Florida (<em>P</em> &lt; 0.0001), between non-Hispanic blacks and Hispanics (in favor of Hispanics) in California (<em>P</em> &lt; 0.0001) and Florida (<em>P</em> &lt; 0.0001), between non-Hispanic blacks and non-Hispanic others (in favor of non-Hispanic others) in California (<em>P</em> &lt; 0.0001) and New York (<em>P</em> &lt; 0.0001), and between Hispanics and non-Hispanic others (in favor of non-Hispanic others) in California (<em>P</em> = 0.001) and New York (<em>P</em> &lt; 0.0001).</p></div><div><h3>Conclusions</h3><p>Disparities in AD pharmacotherapy exposure among minority populations are just as prevalent, if not of greater magnitude, than minority/white disparities.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 5","pages":"Pages 303-312"},"PeriodicalIF":0.0000,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.09.002","citationCount":"27","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal Geriatric Pharmacotherapy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1543594612001122","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 27

Abstract

Background

Treatment disparities in Alzheimer's disease (AD) have received little attention. Determining whether disparities exist in this subpopulation is an important health policy issue.

Objective

The aim was to determine whether an association existed between race/ethnicity and exposure to AD pharmacotherapy across 4 state Medicaid populations.

Methods

Data from the Centers for Medicare and Medicaid Services (CMS) were used in this retrospective study. Persons with AD enrolled in California, Florida, New Jersey, or New York Medicaid programs on January 1, 2004, and remained in that program for 1 year. Individuals had an AD diagnosis based on the ICD-9-CM code 331.0. Outcomes of interest were exposure to a cholinesterase inhibitor (ChEI) or memantine. Multivariate logistic regression was used to test for the association between race/ethnicity and exposure to a ChEI or memantine. Variables of interest included demographic characteristics and resource utilization factors. The Oaxaca-Blinder decomposition method was used to test for disparities to determine whether exposure to AD pharmacotherapy was influenced by race.

Results

Race, age, long-term care admittance, inpatient care admittance, state of residence, and sex were significant predictors of AD pharmacotherapy exposure (P < 0.0001 for all variables). Racial/ethnic disparities were observed with respect to exposure to a ChEI or memantine between non-Hispanic whites and Hispanics (in favor of Hispanics) in Florida (P < 0.0001), between non-Hispanic blacks and Hispanics (in favor of Hispanics) in California (P < 0.0001) and Florida (P < 0.0001), between non-Hispanic blacks and non-Hispanic others (in favor of non-Hispanic others) in California (P < 0.0001) and New York (P < 0.0001), and between Hispanics and non-Hispanic others (in favor of non-Hispanic others) in California (P = 0.001) and New York (P < 0.0001).

Conclusions

Disparities in AD pharmacotherapy exposure among minority populations are just as prevalent, if not of greater magnitude, than minority/white disparities.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
阿尔茨海默病药物治疗暴露的种族和民族差异:对四个州医疗补助人群的分析
背景:阿尔茨海默病(AD)的治疗差异很少受到关注。确定这一亚群中是否存在差异是一个重要的卫生政策问题。目的:在4个州的医疗补助人群中,确定种族/民族与阿尔茨海默病药物治疗暴露之间是否存在关联。方法本回顾性研究采用美国医疗保险和医疗补助服务中心(CMS)的数据。AD患者于2004年1月1日在加州、佛罗里达州、新泽西州或纽约州的医疗补助计划中登记,并在该计划中保留1年。个体根据ICD-9-CM代码331.0进行AD诊断。关注的结果是暴露于胆碱酯酶抑制剂(ChEI)或美金刚。多变量逻辑回归用于检验种族/民族与暴露于ChEI或美金刚之间的关系。感兴趣的变量包括人口特征和资源利用因素。采用Oaxaca-Blinder分解法检验差异,以确定阿尔茨海默病药物治疗暴露是否受种族影响。结果种族、年龄、长期护理入院、住院治疗入院、居住州和性别是AD药物治疗暴露的显著预测因素(P <所有变量为0.0001)。在佛罗里达州,非西班牙裔白人和西班牙裔(支持西班牙裔)之间的ChEI或memantine暴露方面存在种族/民族差异(P <0.0001),在加利福尼亚非西班牙裔黑人和西班牙裔(支持西班牙裔)之间(P <0.0001)和佛罗里达州(P <0.0001),在加利福尼亚非西班牙裔黑人和非西班牙裔其他人(支持非西班牙裔其他人)之间(P <0.0001)和纽约(P <0.0001),以及在加利福尼亚(P = 0.001)和纽约(P <0.0001)。结论:少数民族人群在阿尔茨海默病药物治疗暴露方面的差异与少数民族/白人的差异一样普遍,如果不是更大的话。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
American Journal Geriatric Pharmacotherapy
American Journal Geriatric Pharmacotherapy GERIATRICS & GERONTOLOGY-PHARMACOLOGY & PHARMACY
自引率
0.00%
发文量
0
审稿时长
>12 weeks
期刊最新文献
Author Index Subject Index Editorial Board Adverse Effects of Analgesics Commonly Used by Older Adults With Osteoarthritis: Focus on Non-Opioid and Opioid Analgesics Effect of Combination Fluticasone Propionate and Salmeterol or Inhaled Corticosteroids on Asthma-Related Outcomes in a Medicare-Eligible Population
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1