a University of Toledo , Toledo , OH , USA.
b Department of Health Management and Informatics , University of Central Florida , Orlando , FL , USA.
Curr Med Res Opin. 2019 Aug;35(8):1379-1385. doi: 10.1080/03007995.2019.1586221. Epub 2019 Mar 28.
The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures. A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013-2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping. The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206-0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, < .0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites ( = .01). Non-Hispanics spent significantly less on healthcare compared to Hispanics ( = .04). Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.
本研究旨在确定在患有持续性哮喘的成年人中，种族和民族差异与吸入性皮质类固醇（ICSs）的依从性之间的关系，以及这种差异与医疗支出的关系。本研究使用 2013-2014 年的医疗支出面板调查（MEPS）数据，进行了一项回顾性、横断面研究，纳入了年龄≥18 岁且患有持续性哮喘的患者。采用中位数药物占有率（MPR）来划分依从性水平。采用多元回归分析确定依从性与种族/民族之间的关系。采用对数链接函数和伽马分布的广义线性模型分析总支出与依从性的关系。Bootstrapping 后比较未经调整的支出。277 例患者的平均 ICSs MPR 为 0.34。白人的平均 MPR 水平为 0.33，非裔美国人的平均 MPR 水平为 0.37，其他少数族裔的平均 MPR 水平为 0.35。西班牙裔的平均 MPR 水平为 0.30，非西班牙裔的平均 MPR 水平为 0.35。与白人相比，非裔美国人的依从性较低（OR 0.95）。与白人相比，西班牙裔的依从性较低（OR 0.4；CI 0.206-0.777）。与依从性较低相比，依从性较高与总健康支出显著增加相关（分别为$19,223 和$12,840， < .0001）。与白人相比，非裔美国人的总支出略高；然而，与白人相比，其他少数族裔的健康支出明显较低（ = .01）。与西班牙裔相比，非西班牙裔的医疗保健支出明显较低（ = .04）。这项研究深入了解了与持续性哮喘相关的种族差异的经济成本，进一步证明了可能存在需要解决的种族不平等现象。
