Raver Eli, Jung Jeah, Carlin Caroline, Feldman Roger, Retchin Sheldon, Xu Wendy
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus.
Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia.
JAMA Netw Open. 2025 Apr 1;8(4):e254763. doi: 10.1001/jamanetworkopen.2025.4763.
Older Medicare beneficiaries are susceptible to receiving potentially inappropriate medications (PIMs), where the risks outweigh the benefits. Racial and ethnic differences in PIM use may perpetuate health disparities and disproportionately lead to costly adverse drug events for some groups.
To examine associations of race and ethnicity with PIM use among older Medicare beneficiaries.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationwide Medicare Part D Event files, fee-for-service claims, and Medicare Advantage (MA) encounter data among Medicare beneficiaries 65 years or older with Part D prescription drug coverage. The study population included random samples of 20% of traditional Medicare (TM) beneficiaries and 50% of MA enrollees from January 1, 2016, to December 31, 2019. Analysis was conducted from May 28 to September 16, 2024.
Race and ethnicity.
Linear probability models were estimated for outcomes of (1) high-risk medication use among older adults, (2) potentially harmful drug-disease interactions in patients with dementia, and (3) potentially harmful drug-disease interactions in patients with a history of falls.
The study sample included 21 193 170 patients with 32 199 587 beneficiary-year observations (mean [SD] age, 75.5 [7.3] years; 18 936 697 [58.8%] female; 983 513 [3.1%] Asian or Pacific Islander, 3 190 515 [9.9%] Black, 2 710 930 [8.4%] Hispanic, and 25 314 629 [78.6%] White). Compared with White beneficiaries, the rates of high-risk medication use were 1.7 [95% CI, -1.8 to -1.6] percentage points lower for Asian or Pacific Islander beneficiaries, 3.4 [95% CI, -3.4 to -3.3] percentage points lower for Black beneficiaries, and 0.6 [95% CI, -0.6 to -0.5] percentage points lower for Hispanic beneficiaries. Similarly, White beneficiaries had the highest rates of potentially harmful drug-disease interactions among those with dementia as well as those with a history of falls. The pattern of racial and ethnic differences was similar in analyses stratified by enrollment in TM or MA plans. However, the differences between White individuals and other groups were smaller in MA than in TM plans for all comparisons.
In this cross-sectional study of 32 199 587 Medicare beneficiary-years from 2016 to 2019, White Medicare beneficiaries had consistently higher rates of PIM use compared with other racial and ethnic groups. The observed differences may be partially explained by racial and ethnic differences in overall prescription drug use and suggest the need to reduce PIM use in all racial and ethnic groups.
老年医疗保险受益人容易接受潜在不适当的药物（PIMs），即风险超过益处的药物。PIM使用方面的种族和民族差异可能会使健康差距长期存在，并使某些群体不成比例地面临代价高昂的药物不良事件。
研究老年医疗保险受益人中种族和民族与PIM使用之间的关联。
设计、背景和参与者：这项横断面研究使用了全国医疗保险D部分事件文件、按服务收费索赔以及65岁及以上有D部分处方药保险的医疗保险受益人的医疗保险优势（MA）就诊数据。研究人群包括2016年1月1日至2019年12月31日期间传统医疗保险（TM）受益人的20%随机样本和MA参保人的50%随机样本。分析于2024年5月28日至9月16日进行。
种族和民族。
针对以下结局估计线性概率模型：（1）老年人中高风险药物的使用；（2）痴呆症患者中潜在有害的药物 - 疾病相互作用；（3）有跌倒史患者中潜在有害的药物 - 疾病相互作用。
研究样本包括21193170名患者，有32199587个受益人 - 年观察值（平均[标准差]年龄，75.5[7.3]岁；18936697[58.8%]为女性；983513[3.1%]为亚裔或太平洋岛民，3190515[9.9%]为黑人，2710930[8.4%]为西班牙裔，25314629[78.6%]为白人）。与白人受益人相比，亚裔或太平洋岛民受益人的高风险药物使用率低1.7[95%置信区间，-1.8至-1.6]个百分点，黑人受益人低3.4[95%置信区间，-3.4至-3.3]个百分点，西班牙裔受益人低0.6[95%置信区间，-0.6至-0.5]个百分点。同样，在痴呆症患者以及有跌倒史的患者中，白人受益人发生潜在有害药物 - 疾病相互作用的比率最高。在按TM或MA计划参保分层的分析中，种族和民族差异模式相似。然而，在所有比较中，MA中白人与其他群体之间的差异比TM计划中的差异更小。
在这项对2016年至2019年32199587个医疗保险受益人 - 年的横断面研究中，与其他种族和民族群体相比，白人医疗保险受益人使用PIM的比率一直较高。观察到的差异可能部分由总体处方药使用方面的种族和民族差异所解释，并表明需要减少所有种族和民族群体中PIM的使用。
