title: Racial/Ethnic and gender gaps in the use of and adherence to evidence-based preventive therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction.
abstract: BACKGROUND
  It is unclear whether gender and racial/ethnic gaps in the use of and patient adherence to β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins after acute myocardial infarction have persisted after establishment of the Medicare Part D prescription program.
  
  
  RESULTS
  This retrospective cohort study used 2007 to 2009 Medicare service claims among Medicare beneficiaries ≥65 years of age who were alive 30 days after an index acute myocardial infarction 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 after discharge and patient adherence at 12 months after discharge, adjusting for patient baseline sociodemographic and clinical characteristics. Of 85 017 individuals, 55%, 76%, and 61% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statins, respectively, within 30 days after discharge. No marked differences in use were found by race/ethnicity, but women were less likely to use angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers compared with men. However, at 12 months after discharge, compared with white men, black and Hispanic women had the lowest likelihood (≈30%-36% lower; P<0.05) of being adherent, followed by white, Asian, and other women and black and Hispanic men (≈9%-27% lower; P<0.05). No significant difference was shown between Asian/other men and white men.
  
  
  CONCLUSIONS
  Although minorities were initially no less likely to use the therapies after acute myocardial infarction 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.
authors: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill (J.C.L., C.O., G.F.); and Department of Epidemiology, College of Public Health, and Division of Cardiology, College of Medicine, University of Iowa, Iowa City (J.G.R.).
authors: Julie C
authors: JC
authors: Lauffenburger
authors: Jennifer G
authors: JG
authors: Robinson
authors: Christine
authors: C
authors: Oramasionwu
authors: Gang
authors: G
authors: Fang
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D055118:Medication Adherence / Q000208:ethnology*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000208:ethnology*; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: healthcare disparities; medication adherence; myocardial infarction; secondary prevention