Inequities in Filled Overactive Bladder Medication Prescriptions in the US.
Inequities in Filled Overactive Bladder Medication Prescriptions in the US.
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DOI：
10.1001/jamanetworkopen.2023.15074
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Brown, Oluwateniola
中科院分区：
文献类型：
--
作者：
Luchristt, Douglas;Bretschneider, C. Emi;Kenton, Kimberly;Simon, Melissa;Brown, Oluwateniola
在一项具有全国代表性的美国调查中，人种、种族和其他社会人口学特征是否与使用的膀胱过度活动症药物类型的差异相关？在这项横断面研究中，在控制多个患者因素后，那些被确定为非西班牙裔黑人的患者比非西班牙裔白色个体填写β3-肾上腺素受体激动剂处方与抗胆碱能膀胱过度活动症药物处方的可能性低54%，这些差异具有统计学显著性。鉴于抗胆碱能膀胱过度活动症药物与认知能力下降风险的相关性，观察到的处方差异可能是美国医疗保健系统现有不公平现象的基础和传播。这项横断面研究评价了患者的人种、种族和社会人口学特征是否与接受抗胆碱能药物与β3受体激动剂药物治疗膀胱过度活动症相关。治疗膀胱过度活动症（OAB）的抗胆碱能药物与认知功能下降风险增加相关，而β3-肾上腺素受体激动剂（以下简称β3-激动剂）具有相当的疗效，且不具有相同的风险。然而，抗胆碱能药物仍然是美国处方的主要OAB药物。评价患者人种、种族和社会人口统计学特征是否与接受抗胆碱能药物vs β3受体激动剂OAB药物相关。这项研究是对2019年医疗支出小组调查的横截面分析，该调查是美国家庭的代表性样本。参与者包括具有填写的OAB药物处方的个人。数据分析于2022年3月至8月进行。治疗OAB的药物处方。主要结局为接受β3受体激动剂或抗胆碱能OAB药物治疗。估计有2 971 449人（平均年龄，66.4岁; 95% CI，64.8-68.2岁）2019年填写OAB药物处方; 2 185 214（73.5%; 95% CI，62.6%-84.5%）确定为女性，2 326 901（78.3%; 95% CI，66.3%-90.3%）自我认定为非西班牙裔白色人，260 685（8.8%; 95% CI，5.0%-12.5%）确定为非西班牙裔黑人，167 210（5.6%; 95% CI，3.1%-8.2%）确定为西班牙裔，158 507（5.3%; 95% CI，2.3%-8.4%）被确定为非西班牙裔其他人种，58 147（2.0%; 95% CI，0.3%-3.6%）被确定为非西班牙裔亚裔。共有2 229 297人（75.0%）填写了抗胆碱能药物处方，590 255人（19.9%）填写了β3-激动剂处方，151 897人（5.1%）填写了两种药物类别的处方。β3受体激动剂的中位自付费用为45.00美元（95% CI，42.11 - 47.89美元），而抗胆碱能药物为9.78美元（95% CI，9.16 - 10.42美元）。在控制了保险状况、个人社会人口因素和医疗禁忌症后，非西班牙裔黑人个体比非西班牙裔白色个体填写β3-激动剂与抗胆碱能药物处方的可能性低54%（调整后比值比，0.46; 95% CI，0.22-0.98）。在相互作用分析中，非西班牙裔黑人女性申请β3-激动剂处方的几率更低（调整后的比值比，0.10; 95%CI，0.04-0.27）。在这项对美国家庭代表性样本的横断面研究中，与抗胆碱能OAB处方相比，非西班牙裔黑人个体服用β3-激动剂处方的可能性显著低于非西班牙裔白色个体。这些差异可能反映了不公平的处方行为公布医疗保健的差距。有针对性的研究应评估各种个人和社会因素的相对贡献。
Are race, ethnicity, and other sociodemographic characteristics associated with differences in the type of overactive bladder medication used in a nationally representative US survey? In this cross-sectional study, after controlling for multiple patient factors, those identifying as non-Hispanic Black were 54% less likely than non-Hispanic White individuals to fill a prescription for a β3-adrenoceptor agonist vs an anticholinergic overactive bladder medication, and these differences were statistically significant. Given the association of anticholinergic overactive bladder medications with the risk of cognitive decline, the observed differences in filled prescriptions may underlie and propagate existing inequities in the US health care system. This cross-sectional study evaluates whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist medications to treat overactive bladder. Anticholinergic medications to treat overactive bladder (OAB) have been associated with increased risk of cognitive decline, whereas β3-adrenoceptor agonists (hereafter, β3-agonists) have comparable efficacy and do not carry the same risk. Yet, anticholinergics remain the predominant OAB medication prescribed in the US. To evaluate whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist OAB medications. This study is a cross-sectional analysis of the 2019 Medical Expenditure Panel Survey, a representative sample of US households. Participants included individuals with a filled OAB medication prescription. Data analysis was performed from March to August 2022. A prescription for medication to treat OAB. The primary outcomes were receipt of a β3-agonist or an anticholinergic OAB medication. An estimated 2 971 449 individuals (mean age, 66.4 years; 95% CI, 64.8-68.2 years) filled prescriptions for OAB medications in 2019; 2 185 214 (73.5%; 95% CI, 62.6%-84.5%) identified as female, 2 326 901 (78.3%; 95% CI, 66.3%-90.3%) self-identified as non-Hispanic White, 260 685 (8.8%; 95% CI, 5.0%-12.5%) identified as non-Hispanic Black, 167 210 (5.6%; 95% CI, 3.1%-8.2%) identified as Hispanic, 158 507 (5.3%; 95% CI, 2.3%-8.4%) identified as non-Hispanic other race, and 58 147 (2.0%; 95% CI, 0.3%-3.6%) identified as non-Hispanic Asian. A total of 2 229 297 individuals (75.0%) filled an anticholinergic prescription, and 590 255 (19.9%) filled a β3-agonist prescription, with 151 897 (5.1%) filling prescriptions for both medication classes. β3-agonists had a median out-of-pocket cost of $45.00 (95% CI, $42.11-$47.89) per prescription compared with $9.78 (95% CI, $9.16-$10.42) for anticholinergics. After controlling for insurance status, individual sociodemographic factors, and medical contraindications, non-Hispanic Black individuals were 54% less likely than non-Hispanic White individuals to fill a prescription for a β3-agonist vs an anticholinergic medication (adjusted odds ratio, 0.46; 95% CI, 0.22-0.98). In interaction analysis, non-Hispanic Black women had an even lower odds of filing a β3-agonist prescription (adjusted odds ratio, 0.10; 95% CI, 0.04-0.27). In this cross-sectional study of a representative sample of US households, non-Hispanic Black individuals were significantly less likely than non-Hispanic White individuals to have filled a β3-agonist prescription compared with an anticholinergic OAB prescription. These differences may reflect an inequity in prescribing behaviors promulgating health care disparities. Targeted research should assess the relative contribution of a variety of individual and societal factors.
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