Racial/Ethnic Disparities in Medication Use Among Veterans with Hypertension and Dementia: A National Cohort Study
Racial/Ethnic Disparities in Medication Use Among Veterans with Hypertension and Dementia: A National Cohort Study
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DOI：
10.1345/aph.1l368
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发表时间：
2009-02-01
影响因子：
2.9
通讯作者：
Braun, Ursula K.
中科院分区：
文献类型：
--
作者：
Poon, Ivy;Lal, Lincy S.;Braun, Ursula K.
背景：高血压和合并痴呆是影响老年人的常见疾病。药物依从性对于取得治疗效果至关重要。抗高血压和痴呆药物的使用可能因种族/民族而异，尚未得到很好的探讨。目的：评估不同种族/民族的65岁及以上诊断为高血压和痴呆的退伍军人抗高血压和痴呆药物的使用和依从性。方法：这是一项回顾性队列研究，使用退伍军人健康管理局的2个国家数据库来估计2000年至2005年白人、非洲裔美国人和西班牙裔美国人的药物使用和依从率。药物占有比大于等于0.8定义了依从性。使用多变量logistic回归分析分析种族/民族与依从性之间的关系。结果：65岁及以上的56,561例患者（白人70.5%，非洲裔15.6%，西班牙裔6.6%）诊断为痴呆和高血压。非裔美国人接受血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂（ARBs）、受体阻滞剂、乙酰胆碱酯酶抑制剂和美金刚的可能性低于白人（p < 0.05）。西班牙裔患者比白人更有可能使用ACE抑制剂，而较少使用ARB、受体阻滞剂、非二氢吡啶钙通道阻滞剂（CCB）、环利尿剂、α激动剂或保钾利尿剂（PSD） （p < 0.05）。非裔美国人的药物依从性在除arb、环状利尿剂和psd外的所有类别中均显著低于白人（p < 0.05）。西班牙裔患者对二氢吡啶类CCBs和乙酰胆碱酯酶抑制剂的依从率明显低于白人（p < 0.05）。结论：在老年高血压和痴呆患者队列中，抗高血压和痴呆药物的使用存在种族/民族差异。与白人相比，少数民族对一些抗高血压和痴呆症药物的依从率更低。医疗保健提供者应作出特别努力，提高少数民族的药物依从性。
BACKGROUND: Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored.OBJECTIVE: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups.METHODS: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis.RESULTS: A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, beta-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, alpha-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05).CONCLUSIONS: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.