Gilligan Adrienne M, Malone Daniel C, Warholak Terri L, Armstrong Edward P
College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
Am J Geriatr Pharmacother. 2012 Oct;10(5):303-12. doi: 10.1016/j.amjopharm.2012.09.002.
Treatment disparities in Alzheimer's disease (AD) have received little attention. Determining whether disparities exist in this subpopulation is an important health policy issue.
The aim was to determine whether an association existed between race/ethnicity and exposure to AD pharmacotherapy across 4 state Medicaid populations.
Data from the Centers for Medicare and Medicaid Services (CMS) were used in this retrospective study. Persons with AD enrolled in California, Florida, New Jersey, or New York Medicaid programs on January 1, 2004, and remained in that program for 1 year. Individuals had an AD diagnosis based on the ICD-9-CM code 331.0. Outcomes of interest were exposure to a cholinesterase inhibitor (ChEI) or memantine. Multivariate logistic regression was used to test for the association between race/ethnicity and exposure to a ChEI or memantine. Variables of interest included demographic characteristics and resource utilization factors. The Oaxaca-Blinder decomposition method was used to test for disparities to determine whether exposure to AD pharmacotherapy was influenced by race.
Race, age, long-term care admittance, inpatient care admittance, state of residence, and sex were significant predictors of AD pharmacotherapy exposure (P < 0.0001 for all variables). Racial/ethnic disparities were observed with respect to exposure to a ChEI or memantine between non-Hispanic whites and Hispanics (in favor of Hispanics) in Florida (P < 0.0001), between non-Hispanic blacks and Hispanics (in favor of Hispanics) in California (P < 0.0001) and Florida (P < 0.0001), between non-Hispanic blacks and non-Hispanic others (in favor of non-Hispanic others) in California (P < 0.0001) and New York (P < 0.0001), and between Hispanics and non-Hispanic others (in favor of non-Hispanic others) in California (P = 0.001) and New York (P < 0.0001).
Disparities in AD pharmacotherapy exposure among minority populations are just as prevalent, if not of greater magnitude, than minority/white disparities.
阿尔茨海默病（AD）的治疗差异很少受到关注。确定这一亚人群中是否存在差异是一个重要的卫生政策问题。
旨在确定4个州医疗补助人群的种族/族裔与AD药物治疗暴露之间是否存在关联。
本回顾性研究使用了医疗保险和医疗补助服务中心（CMS）的数据。2004年1月1日参加加利福尼亚州、佛罗里达州、新泽西州或纽约州医疗补助计划且在该计划中持续参保1年的AD患者。根据国际疾病分类第九版临床修订本（ICD-9-CM）代码331.0确诊为AD。感兴趣的结局是胆碱酯酶抑制剂（ChEI）或美金刚的使用情况。采用多因素logistic回归分析种族/族裔与ChEI或美金刚使用之间的关联。感兴趣的变量包括人口统计学特征和资源利用因素。采用奥克萨卡-布林德分解法检验差异，以确定AD药物治疗暴露是否受种族影响。
种族、年龄、长期护理入院情况、住院护理入院情况、居住州和性别是AD药物治疗暴露的显著预测因素（所有变量P<0.0001）。在佛罗里达州，非西班牙裔白人与西班牙裔之间（西班牙裔更占优势）在ChEI或美金刚使用方面存在种族/族裔差异（P<0.0001）；在加利福尼亚州（P<0.0001）和佛罗里达州（P<0.0001），非西班牙裔黑人和西班牙裔之间（西班牙裔更占优势）存在差异；在加利福尼亚州（P<0.0001）和纽约州（P<0.0001），非西班牙裔黑人和非西班牙裔其他种族之间（非西班牙裔其他种族更占优势）存在差异；在加利福尼亚州（P=0.001）和纽约州（P<0.0001），西班牙裔和非西班牙裔其他种族之间（非西班牙裔其他种族更占优势）存在差异。
少数族裔人群在AD药物治疗暴露方面的差异即便不比少数族裔/白人之间的差异更大，也同样普遍。
