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. 2014 Feb 18;129(7):754-63.
doi: 10.1161/CIRCULATIONAHA.113.002658. Epub 2013 Dec 10.

Racial/Ethnic and gender gaps in the use of and adherence to evidence-based preventive therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction

Julie C Lauffenburger  1 , Jennifer G Robinson, Christine Oramasionwu, Gang Fang
Affiliations

Racial/Ethnic and gender gaps in the use of and adherence to evidence-based preventive therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction

Julie C Lauffenburger et al. Circulation. .

Abstract

Background: It is unclear whether gender and racial/ethnic gaps in the use of and patient adherence to β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins after acute myocardial infarction have persisted after establishment of the Medicare Part D prescription program.

Methods and results: This retrospective cohort study used 2007 to 2009 Medicare service claims among Medicare beneficiaries ≥65 years of age who were alive 30 days after an index acute myocardial infarction hospitalization in 2008. Multivariable logistic regression models examined racial/ethnic (white, black, Hispanic, Asian, and other) and gender differences in the use of these therapies in the 30 days after discharge and patient adherence at 12 months after discharge, adjusting for patient baseline sociodemographic and clinical characteristics. Of 85 017 individuals, 55%, 76%, and 61% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statins, respectively, within 30 days after discharge. No marked differences in use were found by race/ethnicity, but women were less likely to use angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers compared with men. However, at 12 months after discharge, compared with white men, black and Hispanic women had the lowest likelihood (≈30%-36% lower; P<0.05) of being adherent, followed by white, Asian, and other women and black and Hispanic men (≈9%-27% lower; P<0.05). No significant difference was shown between Asian/other men and white men.

Conclusions: Although minorities were initially no less likely to use the therapies after acute myocardial infarction discharge compared with white patients, black and Hispanic patients had significantly lower adherence over 12 months. Strategies to address gender and racial/ethnic gaps in the elderly are needed.

Keywords: healthcare disparities; medication adherence; myocardial infarction; secondary prevention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Robinson received research grants awarded to the University of Iowa from Abbott, Daiichi-Sankyo, Esperion, GlaxoSmithKline, and Merck. Dr. Lauffenburger receives support from the National Institute of Nursing Research (T32NR008856).

Comment in

References

    1. McGovern PG, Pankow JS, Shahar E, Doliszny KM, Folsom AR, Blackburn H, Luepker RV. Recent trends in acute coronary heart disease — mortality, morbidity, medical care, and risk factors. N Engl J Med. 1996;334:884–890. - PubMed
    1. Vaccarino V, Rathore SS, Wenger NK, Frederick PD, Abramson JL, Barron HV, Manhapra A, Mallik S, Krumholz HM, National Registry of Myocardial Infarction I Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. The N Engl J Med. 2005;353:671–682. - PMC - PubMed
    1. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in u.S. Deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388–2398. - PubMed
    1. Chen J, Normand SLT, Wang Y, Drye EE, Schreiner GC, Krumholz HM. Recent declines in hospitalizations for acute myocardial infarction for medicare fee-for-service beneficiaries. Circulation. 2010;121:1322–1328. - PubMed
    1. Gan SC, Beaver SK, Houck PM, MacLehose RF, Lawson HW, Chan L. Treatment of acute myocardial infarction and 30-day mortality among women and men. N Engl J Med. 2000;343:8–15. - PubMed

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