Racial Differences in Lipid-Lowering Agent Use in Medicaid Patients With Cardiovascular Disease

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Abstract
Racial differences in chronic cardiovascular disease (CVD) outcomes are well described, whereas less is known about the process of CVD preventive care and its potential contribution to disparate outcomes. The objective of this study was to examine the association between race and 1) prior use of a lipid-lowering agent (LLA), 2) LLA initiation, and 3) LLA discontinuation among individuals with an incident medical claim for CVD. Retrospective claims analysis. We studied continuously enrolled, fee-for-service Medicaid recipients <65 with a new medical claim for 1 of 15 CVD-related diagnoses or procedures from 1993 to 1998 (n = 14,833). Pharmacy claims history reflecting previous, new, and ongoing LLA use were reviewed for the 24-month period around a new CVD claim. Multivariable logistic regression assessed the independent effect of minority status on new and ongoing LLA use controlling for clinical and demographic characteristics. A total of 3924 (26.4%) individuals submitted LLA pharmacy claims. A total of 3668 of 4668 (78.6%) previous or new users obtained ≥1 refill. Minorities were less likely to have previously used LLA (adjusted odds ratio [AOR], 0.64; 95% confidence interval [CI], 0.58–0.70), to receive a new prescription (AOR, 0.62; 95% CI, 0.54–0.71), or to continue use, as evidenced by subsequent refill claims (AOR, 0.74; 95% CI, 0.62–0.87). Publicly insured minorities with prescription coverage benefit less often from preventive care before or after a CVD diagnosis, resulting, in part, from providers’ failure to initiate therapy and patients’ failure to continue it. To reduce widening disparities in cardiovascular outcomes, strategies that target LLA underuse by minorities throughout the process of care are needed.