Racial/Ethnic and Gender Gaps in the Use and Adherence of Evidence-Based Preventive Therapies among Elderly Medicare Part D Beneficiaries after Acute Myocardial Infarction
Background—It is unclear whether gender and racial/ethnic gaps in the use of and patient adherence to β-blockers, angiotensin-converting-enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and HMG-CoA reductase inhibitors (statins) post-acute myocardial infarction (AMI) have persisted following establishment of the Medicare Part D prescription program.
Methods and Results—This retrospective cohort study used 2007-2009 Medicare service claims among Medicare beneficiaries ≥ 65 years who were alive 30 days after an index AMI 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 post-discharge and patient adherence at 12-months post-discharge, adjusting for patient baseline sociodemographic and clinical characteristics. Out of 85,017 individuals, 55%, 76%, and 61% used ACEIs/ARBs, β-blockers, and statins within 30 days post-discharge, respectively. No marked differences in use were found by race/ethnicity but women were less likely to use ACEI/ARBs and β-blockers compared with men. However, at 12-months post-discharge compared with white men, black and Hispanic women had the lowest likelihood (approximately 30-36% lower, p <0.05) of being adherent, followed by white, Asian, and other women and black and Hispanic men (approximately 9-27% lower, p <0.05). No significant difference was shown between Asian/other men and white men.
Conclusions—While minorities were initially no less likely to use the therapies post-AMI 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.
- Received March 15, 2013.
- Revision received October 24, 2013.
- Accepted November 4, 2013.