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Minority Health/Disparities

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Study confirms underuse of lipid-lowering agents by Medicaid-insured minority patients with cardiovascular disease

People who are diagnosed with cardiovascular disease (CVD, including coronary heart disease, stroke, and peripheral vascular disease) can reduce their risk of complications and death in several ways. These include proper diet, regular exercise, weight control, and in some instances, use of beta-blockers and lipid-lowering agents (LLA).

Minority patients younger than age 65 who are insured by Medicaid and have full medication prescription benefits are less likely than their white counterparts to benefit from use of LLA both before or after a CVD diagnosis, according to a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00059). This disparity results in part from providers' failure to initiate LLA therapy and in part from patients' failure to continue it.

Strategies that target LLA underuse by minorities throughout the process of CVD care are needed, according to David Litaker, M.D., Ph.D., and Siran M. Koroukian, Ph.D., of Case Western Reserve University. They analyzed Ohio Medicaid claims and LLA pharmacy claims for Medicaid-insured individuals younger than 65 who had a new medical claim for 1 of 15 CVD-related diagnoses or procedures from 1993 to 1998. They assessed the independent effect of minority status on new and ongoing LLA use, while controlling for clinical and demographic characteristics.

Overall, 26.4 percent of individuals (3,668 of 4,668) submitted LLA pharmacy claims, and 78.6 percent of previous or new users of LLA obtained one or more refills. Compared with whites, minorities were 36 percent less likely to have previously used an LLA, 38 percent less likely to receive a new LLA prescription, and 26 percent less likely to continue use, as evidenced by subsequent refill claims. Racial disparities in cardiovascular outcomes are unlikely to be reduced in the future without considerable and concerted efforts that target both the patient and health care provider, conclude the researchers.

See "Racial differences in lipid-lowering agent use in Medicaid patients with cardiovascular disease," by Drs. Litaker and Koroukian, in the October 2004 Medical Care 42(10), pp. 1009-1018.

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