Frequency of Disparities in Laboratory Testing After Statin Initiation in Subjects ≥65 Years.
Laboratory testing is important for the safety of older adults initiating statins, but there has been little examination of laboratory testing disparities by race/ethnicity, age, gender, Medicaid eligibility, and multimorbidity. The study's purpose was to examine disparities in guideline-concordant baseline laboratory testing and abnormal laboratory values among a retrospective cohort of 76,868 Medicare fee-for-service beneficiaries from 10 states in the eastern United States who had dyslipidemia and initiated a statin from July 1 to November 30, 2011. Guideline-concordant assessment of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was defined as evidence of an outpatient claim for either test within 180 days before or 14 days after the date of the index statin fill. In 2011, baseline laboratory testing rates were 89.3% for ALT and 88.8% for AST. Older adults were somewhat more likely to have ALT and AST testing if they were dually enrolled in Medicaid (relative risk 1.01, 95% confidence interval [CI] 1.00 to 1.02) or had multiple chronic conditions (relative risk 1.03, 95% CI 1.00 to 1.06 for 2 to 3 conditions; odds ratio [OR] 1.08, 95% CI 1.05 to 1.11 for 4 to 5 conditions; OR 1.14, 95% CI 1.11 to 1.17 for 6+ conditions), compared with 0 to 1 conditions. Non-Hispanic blacks were less likely to receive baseline testing (OR 0.97, 95% CI 0.96 to 0.98) than non-Hispanic Whites, and male beneficiaries were somewhat less likely to receive testing than female beneficiaries (OR 0.99, 95% CI 0.98 to 0.99). Abnormal values were rare. In conclusion, ALT and AST assessment after statin initiation was commonly done as recommended, and there were negligible disparities in testing rates for beneficiaries.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: mlm34@duke.edu.
Matthew L
ML
Maciejewski
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Xiaojuan
X
Mi
Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Lesley H
LH
Curtis
National Committee for Quality Assurance, Washington, District of Columbia.
Judy
J
Ng
Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Samuel C
SC
Haffer
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Bradley G
BG
Hammill
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015897:Comorbidity; D050171:Dyslipidemias / Q000188:drug therapy*; D004608:Eligibility Determination; D005006:Ethnicity / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008111:Liver Function Tests / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare; D016345:Medicare Part B; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D044465:White People
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase