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.
J Clin Lipidol. 2013 Nov-Dec;7(6):675-82. doi: 10.1016/j.jacl.2013.03.010. Epub 2013 Apr 3.
Across the United States, hyperlipidemia remains inadequately controlled and may vary across states according to differences in health insurance coverage and/or race/ethnicity.
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.
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.
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.
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.
在美国各地，高血脂的控制仍然不理想，根据医疗保险覆盖范围和/或种族/民族的差异，各州的情况可能有所不同。
研究美国 50 个州和哥伦比亚特区的医疗保险和种族/民族特征与高血脂管理措施之间的关系。
使用交叉验证的多元线性回归模型分析各州的医疗保险模式或少数民族比例（来自 2010 年美国人口普查数据）与各州在过去 5 年内检查胆固醇的总频率或开处降脂药物的处方（分别来自全国调查和人口调整后的零售处方数据）之间的关联，同时调整年龄、性别、体重指数、种族/民族和贫困因素。
在保险比例较高的州，胆固醇检查的频率较低，但在私人保险、医疗保险或医疗补助比例较高的州，医生不一定更倾向于检查胆固醇或开更多的处方。在黑人比例较高和/或西班牙裔比例较高的州，胆固醇更有可能被检查，但在黑人比例较高的州，开的处方更多，而在西班牙裔比例较高的州，开的他汀类药物处方则较少。
各州在保险和种族/民族构成方面的差异与高血脂管理方面的差异有关；保险较少的州可能效果较差，而私人保险、医疗保险或医疗补助较多的州可能效果也不一定更好。在黑人比例较高的州与西班牙裔比例较高的州相比，降脂药物的使用可能有所不同。我们的发现值得进一步研究。
