title: Differences in cholesterol management among states in relation to health insurance and race/ethnicity across the United States.
abstract: BACKGROUND
  Across the United States, hyperlipidemia remains inadequately controlled and may vary across states according to differences in health insurance coverage and/or race/ethnicity.
  
  
  OBJECTIVE
  To examine relationships between states' health insurance and race/ethnicity characteristics with measures of hyperlipidemia management across the 50 U.S. states and the District of Columbia.
  
  
  METHODS
  Cross-validated, multiple linear regression modeling was used to analyze associations between states' health insurance patterns or proportions of racial minorities (from the 2010 U.S. Census data) and states' aggregate frequency of checking cholesterol within the previous 5 years or prescriptions written for lipid-lowering medications (from national survey and population-adjusted retail prescription data, respectively), with adjustments for age, sex, body mass index, race/ethnicity, and poverty.
  
  
  RESULTS
  In states with proportionately more uninsured, cholesterol levels are checked less often, but in states with proportionately more private, Medicare, or Medicaid coverage, providers are not necessarily more likely to check cholesterol or to write more prescriptions. In states with proportionately more African-Americans and/or Hispanics, cholesterol is more likely to be checked, but in states with more African-Americans, more prescriptions were written, whereas in states with more Hispanics, fewer statin prescriptions were written.
  
  
  CONCLUSIONS
  Variations across states in insurance and racial/ethnicity mix are associated with variations in hyperlipidemia management; less-insured states may be less effective whereas states with more private, Medicare, or Medicaid coverage may not be more effective. In states with proportionately more African-Americans vs. Hispanics, lipid medications may be prescribed differently. Our findings warrant further investigations.
authors: Division of Endocrinology, Metabolism & Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA 90059, USA. Electronic address: stanleyhsia@cdrewu.edu.
authors: Stanley H
authors: SH
authors: Hsia
authors: Monica L
authors: ML
authors: Desnoyers
authors: Martin L
authors: ML
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy / Q000208:ethnology; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D014481:United States / Q000208:ethnology; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D002784:Cholesterol
keywords: Cholesterol screening; Ethnicity; HMG-CoA reductase inhibitors; Health insurance; Lipid lowering medications; Race