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Am Heart J. 2013 Oct;166(4):792-7. doi: 10.1016/j.ahj.2013.07.001. Epub 2013 Aug 28.

Racial differences in antilipemic use and lipid control in high-risk older adults: post-Medicare Part D.

Author information

1
Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PA. Electronic address: jth14@pitt.edu.

Abstract

BACKGROUND:

Older blacks are less likely to receive guideline-recommended antilipemic therapy and achieve lipid control than older whites because, in part, of out-of-pocket costs. We sought to determine whether racial differences in antilipemic use and lipid control narrowed after Medicare Part D's implementation.

METHODS:

This before-after study included 1,091 black and white adults 70 years or older with coronary heart disease and/or diabetes mellitus from the Health Aging and Body Composition Study. Primary outcomes were antilipemic use and low-density lipoprotein cholesterol control. Key independent variables were race, time (pre-Part D vs post-Part D), and their interaction.

RESULTS:

Before Part D, fewer blacks than whites reported taking an antilipemic (32.70% vs 49.35%), and this difference was sustained after Part D (blacks 48.30% vs whites 64.57%). Multivariable generalized estimating equations confirmed no post-Part D change in racial differences in antilipemic use (adjusted ratio of the odds ratio 1.07, 95% CI 0.79-1.45). Compared with whites, more blacks had poor lipid control both before Part D (24.30% vs 12.36%, respectively) and after Part D (24.46% vs 13.72%, respectively), with no post-Part D change in racial differences in lipid control (adjusted ratio of the odds ratio 0.82, 95% CI 0.51-1.33).

CONCLUSION:

Although antilipemic use increased after Medicare Part D for both races, this policy change was associated with a change neither in lipid control for either racial group nor in the racial differences in antilipemic use or lipid control.

PMID:
24093862
PMCID:
PMC3801224
DOI:
10.1016/j.ahj.2013.07.001
[Indexed for MEDLINE]
Free PMC Article
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