title: Race/Ethnicity, disability, and medication adherence among medicare beneficiaries with heart failure.
abstract: BACKGROUND
  Recent and national data on adherence to heart failure drugs are limited, particularly among the disabled and some small minority groups, such as Native Americans and Hispanics.
  
  
  OBJECTIVE
  We compare medication adherence among Medicare patients with heart failure, by disability status, race/ethnicity, and income.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  US Medicare Parts A, B, and D data, 5% random sample, 2007-2009.
  
  
  METHODS
  149,893 elderly Medicare beneficiaries and 21,204 disabled non-elderly beneficiaries.
  
  
  METHODS
  We examined 5% of Medicare fee-for-service beneficiaries with heart failure in 2007-2009. The main outcome was 1-year adherence to one of three therapeutic classes: β-blockers, diuretics, and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs). Adherence was defined as having prescriptions in possession for ≥ 75% of days.
  
  
  RESULTS
  Among aged beneficiaries, 1-year adherences to at least one heart failure drug were 63%, 57%, 53%, 50%, and 52% for Whites, Asians, Hispanics, Native Americans and Blacks, respectively; among the disabled, 1-year adherence was worse for each group: 57%, 53%, 48%, 44% and 43% respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location and health status. Patterns of adherence were similar among beneficiaries on all three therapeutic classes. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to Whites, OR = 0.61 (95% CI 0.58-0.64) for Hispanics, OR = 0.59 (95% CI 0.57-0.62) for Blacks and OR = 0.57 (95% CI 0.47-0.68) for Native Americans.
  
  
  CONCLUSIONS
  After the implementation of Medicare Part D, adherence to heart failure drugs remains problematic, especially among disabled and minority beneficiaries, including Native Americans, Blacks, and Hispanics. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, ytzhang@pitt.edu.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
authors.forename: Seo Hyon
authors.initials: SH
authors.lastname: Baik
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D001213:Asian / Q000208:ethnology; D001741:Black or African American / Q000208:ethnology; D005006:Ethnicity; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics / Q000208:ethnology; D006630:Hispanic or Latino / Q000208:ethnology; D007182:Income / Q000639:trends; D007198:Indians, North American / Q000208:ethnology; D054524:Medicare Part D / Q000191:economics / Q000639:trends; D055118:Medication Adherence / Q000208:ethnology; D006233:Persons with Disabilities; D044469:Racial Groups / Q000208:ethnology; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology