Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
Curr Med Res Opin. 2022 Oct;38(10):1715-1725. doi: 10.1080/03007995.2022.2103962. Epub 2022 Aug 9.
Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD).
Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017.
In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD.
Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.
之前对政策方案的分析报告称，在医疗保险药物治疗管理（MTM）计划中，资格认定存在差异。随着最近发布的 MTM 数据，本研究旨在确定在 Medicare 受益人群中，患有阿尔茨海默病和相关痴呆症（ADRD）的患者中，是否存在 MTM 注册方面的种族/民族差异。
对 2013-2014 年和 2016-2017 年的医疗保险索赔/记录（与地区卫生资源文件相关联）进行了检查。纳入的患者为患有 ADRD 以及糖尿病、高血压或高血脂的患者。在描述性分析中，比较非西班牙裔白人（白人）患者和少数族裔群体之间 MTM 注册比例。使用调整患者和社区特征的逻辑回归来检查种族/民族差异。通过估计 2016-2017 年每个少数族裔群体和虚拟变量之间的交互项的逻辑回归模型来比较研究期间的差异。
在未调整的分析中，少数民族的注册比例高于白人。例如，在 2016-2017 年，白人、黑人、西班牙裔、亚洲/太平洋岛民（亚洲人）和其他人的注册百分比分别为 14.44%、16.71%、19.83%、16.66%和 17.78%。在调整分析中，在所有队列中，黑人的注册几率均低于白人。例如，在整个研究样本中，患有 ADRD 的黑人参加 MTM 的几率比白人低 9%（优势比 0.91，95%置信区间[CI] = 0.86-0.97）。在 ADRD 样本以及所有亚组中，这些差异随时间而减少。例如，黑人与 2016-2017 年之间的交互项表明，在患有 ADRD 的人群中，差异降低了 11%（优势比 1.11，95%CI = 1.05-1.16）。
患有 ADRD、糖尿病、高血压或高血脂的黑人参加 MTM 的可能性低于白人。种族差异随时间减少，但并未消除。
