Article

Utilizing new prescription drugs: Disparities among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites

University of Maryland, Baltimore, Baltimore, Maryland, United States
Health Services Research (Impact Factor: 2.49). 08/2007; 42(4):1499-519. DOI: 10.1111/j.1475-6773.2006.00682.x
Source: PubMed

ABSTRACT To examine racial and ethnic disparities in new prescription drug use.
Secondary data analyses of the Medical Expenditure Panel Survey (1996-2001), a national survey representative of U.S. noninstitutionalized civilian population. Drug approval dates were from the GenRx database of Mosby.
A negative binomial model was used to compare annual number of times when new drugs were obtained across racial and ethnic groups. Covariates in the model were demographic, economic characteristics, and health status. Drugs were considered new if approved within the past 5 years. We compared non-Hispanic whites with non-Hispanic blacks, and non-Hispanic whites with Hispanic whites, respectively, to examine racial and ethnic disparities separately.
Descriptive analyses found smaller racial disparities than ethnic disparities: the average annual number of times when new drugs were obtained was higher among non-Hispanic whites than non-Hispanic blacks (1.71 versus 1.36; p<.01) and Hispanic whites (1.71 versus 1.11; p<.01). Multivariate analyses found smaller ethnic than racial disparities: the number was 22-33 percent lower among non-Hispanic blacks than non-Hispanic whites (significant), and 5-16 percent lower among Hispanic whites than non-Hispanic whites (not always significant), respectively. While the absolute racial disparities decreased over the early years of the life cycles of the products, the reduction in disparities over time was not significant.
There are racial disparities in the use of new medications, which persist during the first 5 years of marketing. Socioeconomic and health characteristics account for a larger share of ethnic disparities than racial disparities.

0 Followers
 · 
127 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Determine whether the implementation of the Medicare Part D 2006 was associated with changes in differential racial and ethnic disparity patterns between the individuals ineligible for medication therapy management (MTM) services and MTM-eligible individuals. The urgency for modifying MTM eligibility criteria would be increased if the reduction of disparity not seen. Methods: Data from the Medicare Current Beneficiary Survey were analyzed. A difference-in-differences analyses, difference-in-differences-in-differences-in-differences (DDDD) model, was used to examine changes in difference in disparities between the MTM-ineligible and MTM-eligible individuals from 2004-2005 to 2007-2008 in relation to the changes from 2001-2002 to 2004-2005. Disparities were examined in health outcomes, health services utilizations/costs, and medication utilization. Both main and sensitivity analyses were conducted by various regression models. Findings: The main analysis found no significant DDDD values. For racial disparities, according to some sensitivity analyses, Part D implementation was associated with a reduction in greater racial disparities among the MTM-ineligible and MTM-eligible individuals in activities of daily living (DDDD=1.13; P=0.03 for one analysis) and instrumental activities of daily living (DDDD=0.95; P=0.03 for one analysis). For ethnic disparities, Part D implementation was associated with reduction in any greater disparities among the MTM-ineligible than MTM-eligible individuals in costs of physician visits (DDDD=-4613.71; P=0.04 for one analysis) and high risk medication utilization (DDDD=-0.10; P=0.03 for one analysis). Conclusions: Part D implementation is not consistently associated with reductions in the disparity implications of the Medicare MTM eligibility criteria. The MTM eligibility criteria need to be modified in order to eliminate their disparity implications.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Medication therapy management (MTM) has the potential to play an instrumental role in reducing racial and ethnic disparities in health care. However, previous research has found that blacks and Hispanics are less likely to be eligible for MTM. The purpose of the current study was to examine the potential effects of MTM eligibility criteria on racial and ethnic disparities in health outcomes.Methods The current study is a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey Cost and Use files for the years 2007 and 2008. A difference-in-differences model was used to compare disparities in outcomes between ineligible and eligible beneficiaries according to MTM eligibility criteria in 2010. This was achieved by including in regression models interaction terms between dummy variables for blacks/Hispanics and MTM eligibility criteria. Interaction terms were interpreted on both multiplicative and additive terms. Various regression models were used depending on the types of variables.Key findingsWhites were more likely to report self-perceived good health status than blacks and Hispanics among both MTM-eligible and MTM-ineligible populations. Disparities were greater among MTM-ineligible than MTM-eligible populations (e.g. on additive term, difference in odds = 1.94 and P < 0.01 for whites and blacks; difference in odds = 2.86 and P < 0.01 for whites and Hispanics). A few other measures also exhibited significant patterns.ConclusionsMTM eligibility criteria may exacerbate racial and ethnic disparities in health status and some measures of health services utilizations and costs and medication utilization. Future research should examine strategies to remediate the effects of MTM eligibility criteria on disparities.
    06/2014; 5(2). DOI:10.1111/jphs.12055
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Retail prescription fill data have consistently shown wide variation in prescription drug utilization across states, with state-level rates ranging from 8.5 to 19.3 filled prescriptions per capita per year. Empirical explanations for this wide variation have not yet been sought. Objectives To examine which factors potentially explain the wide variation in prescription drug utilization across US states. Methods Summary data (proportions, counts, rates, etc) on sociodemographics, health, insurance, provider density, health service use, and retail prescription drug fills for each of the 50 states and the District of Columbia, from 2008 to 2010, were retrieved from multiple national data sources, such as the Kaiser Family Foundation’s “State Health Facts” Web Portal. Pooled cross-sectional linear, negative binomial, and ordered logit multivariable regressions were used to model states’ prescription utilization as a function of the aforementioned possible explanatory variables. Principal components analysis also was employed so as to overcome high correlations among some of the covariates. Results Among US states, higher levels of employer-sponsored insurance or Medicaid coverage were associated with both higher levels of prescription utilization and a higher likelihood of being in upper utilization quartiles. A higher density of nurse practitioners was also positively associated with both the level of utilization and the likelihood of higher utilization, whereas a higher density of active physicians was associated with opposite effects. Higher prevalence of physical activity was associated with lower utilization levels as well as a lower likelihood of high utilization. State-level prevalence of chronic conditions and poor health mattered only for the level of prescription utilization. States’ sociodemographics were not significantly associated with prescription utilization. Conclusions This study suggests that higher prescription utilization across states was associated with the variations in provider types, Medicaid and private insurance coverage, as well as the prevalence of chronic diseases. Further investigation of how each of these factors may contribute to a particular state’s prescription drug utilization level is needed.
    Research in Social and Administrative Pharmacy 11/2014; 10(6). DOI:10.1016/j.sapharm.2014.02.003 · 2.35 Impact Factor

Full-text (2 Sources)

Download
43 Downloads
Available from
May 26, 2014