Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study
Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study
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DOI：
10.1007/s11606-010-1588-2
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发表时间：
2011-05-01
影响因子：
5.7
通讯作者：
Mangione, Carol M.
中科院分区：
文献类型：
--
作者：
Duru, O. Kenrik;Bilik, Dori;Mangione, Carol M.
讲西班牙语和/或社会经济地位低的患者血糖控制欠佳的风险更大。降糖药物强化不足可能部分解释了这种差异。为了研究主要语言、收入和药物强化之间的关系，进行了一项随访18个月的队列研究。1939名未使用胰岛素的2型糖尿病患者参加了糖尿病研究转化为行动（TRIAD），一项关于管理式护理中糖尿病护理的研究。使用管理药房数据，我们通过主要语言和年收入，比较了基线A1 c为a千分之一日元/欧元8%的患者的药物强化的几率。协变量包括年龄、性别、种族/民族、教育、Charlson评分、糖尿病病程、基线A1 c、糖尿病治疗类型和健康计划。我们发现，讲英语的人与讲西班牙语的人的强化几率没有差异。然而，与收入为75，000美元的患者相比（OR 2.22，1.53-3.24），强化的几率增加。后一种模式在种族之间没有统计学差异，低收入患者接受药物强化治疗的可能性低于高收入患者，但主要语言（西班牙语与英语）与管理式护理环境中强化治疗的差异无关。未来的研究需要解释低收入患者在管理式护理中强化率降低的原因。
Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity.To examine the associations between primary language, income, and medication intensification.Cohort study with 18-month follow-up.One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care.Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c a parts per thousand yenaEuro parts per thousand 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan.Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes $75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race.Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.