Department of Biostatistics and Epidemiology of the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
J Diabetes Complications. 2012 Jul-Aug;26(4):301-7. doi: 10.1016/j.jdiacomp.2012.04.001. Epub 2012 May 31.
Prescription rates for diabetic drugs vary considerably across the United States for Medicare beneficiaries. The goal of this study was to determine if non-clinical factors (patient race, ethnicity, gender, income) are associated with regional variation in pharmacotherapy decisions for diabetic patients enrolled in Medicare.
We performed a spatially-weighted, linear regression analysis of the entire diabetic population enrolled in Medicare Parts A, B, and D for the years 2006 through 2009. Our outcomes of interest were the percentage of diabetic patients being treated with metformin, a sulfonylurea, a thiazolidinedione, or insulin within a hospital referral region (HRR).
Prescription rates for metformin, sulfonylureas, thiazolidinediones, and insulin varied more than two-fold between hospital referral region. Metformin prescription rates were increased in western states while prescription rates for sulfonylureas and insulins were highest in the South and Midwest. In contrast with these other diabetic drug classes, members of the thiazolidinedione drug class were prescribed more frequently in the Central United States (Great Plains, Colorado Rockies, Northern Texas, Oklahoma). Prescription rates for each drug class were increased in hospital referral regions with a lower household income. Referral regions with larger African American populations were associated with higher prescription rates for insulin (p<0.001) and lower prescription rates for metformin (p<0.001). Gender and Hispanic ethnicity were not associated with regional variation in prescription rates for the four major diabetic drug classes.
Geographic differences exist in the management of type 2 diabetes for Medicare enrollees. Prescription patterns were associated with household income and African American race. Further studies are necessary to identify local, unidentified factors that might be influencing provider management styles.
美国医疗保险受益人的糖尿病药物处方率存在很大差异。本研究的目的是确定非临床因素（患者种族、族裔、性别、收入）是否与医疗保险中糖尿病患者药物治疗决策的区域差异有关。
我们对 2006 年至 2009 年医疗保险 A、B 和 D 部分登记的所有糖尿病患者进行了空间加权线性回归分析。我们感兴趣的结果是在医院转诊区域（HRR）内接受二甲双胍、磺酰脲类、噻唑烷二酮或胰岛素治疗的糖尿病患者比例。
不同医院转诊区域的二甲双胍、磺酰脲类、噻唑烷二酮和胰岛素的处方率差异超过两倍。西部州的二甲双胍处方率增加，而南部和中西部的磺酰脲类和胰岛素处方率最高。与其他糖尿病药物类别不同，噻唑烷二酮类药物在中美洲（大平原、科罗拉多落矶山、北德克萨斯、俄克拉荷马）的处方频率更高。家庭收入较低的医院转诊区域的每种药物类别的处方率均增加。非裔美国人比例较大的转诊区域与胰岛素处方率较高（p<0.001）和二甲双胍处方率较低（p<0.001）相关。性别和西班牙裔种族与四大类糖尿病药物的处方率区域差异无关。
医疗保险参保者 2 型糖尿病的管理存在地理差异。处方模式与家庭收入和非裔美国人种族有关。需要进一步研究以确定可能影响提供者管理方式的当地未知因素。
