Disparities in use of lipid-lowering medications among people with type 2 diabetes mellitus.
BACKGROUND
People with diabetes are at high risk for cardiovascular events regardless of known heart disease. Physicians may underrecognize the excess cardiovascular risk conferred by diabetes alone, without a recent cardiovascular event. Other disparities in the receipt of lipid-lowering medications (LLMs) may exist.


METHODS
We studied veterans with diabetes in fiscal years 1998 and 1999 cross-sectionally. We used administrative data (demographic information, International Classification of Diseases, Ninth Revision [ICD-9] codes, utilization information, medications, and laboratory tests) to evaluate associations between use of LLMs and age, ethnicity, sex, marital status, Charlson Index, heart disease ICD-9 codes, oral agents and insulin, hospitalization status, and low-density lipoprotein cholesterol levels. We constructed separate logistic regression models to evaluate associations between low-density lipoprotein cholesterol and similar predictor variables.


RESULTS
Odds ratios were similar in both years. For fiscal year 1999, patients without recent ICD-9 codes in their administrative data indicating heart disease were 0.35 times less likely to be given LLMs than those with such codes. Individuals older than 75 years were 0.65 times less likely to be given LLMs than those younger than 65 years. African Americans were 0.72 times less likely than whites to be given LLMs. In fiscal years 1999 and 1998, 27% and 36% of individuals given LLMs had low-density lipoprotein cholesterol levels higher than 130 mg/dL (3.37 mmol/L).


CONCLUSIONS
Veterans with diabetes but no recently coded heart disease, older individuals, and African Americans could benefit from programs targeted to introduce LLMs. Up to one third of individuals given LLMs remained above the target level of 130 mg/dL for low-density lipoprotein cholesterol.
Safford
Monika
M
New Jersey Veterans Health Administration Healthcare System, East Orange, NJ, USA. safford@umdnj.edu
Eaton
Laura
L
Hawley
Gerald
G
Brimacombe
Michael
M
Rajan
Mangala
M
Li
Huiling
H
Pogach
Leonard
L
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006787:Hospitals, Veterans; D006801:Humans; D006949:Hyperlipidemias / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D014280:Triglycerides / Q000097:blood; D014481:United States; D014728:Veterans
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D014280:Triglycerides