Racial and Ethnic Disparities among Enrollees in Medicare Advantage Plans
Racial and Ethnic Disparities among Enrollees in Medicare Advantage Plans
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DOI：
10.1056/nejmsa1407273
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发表时间：
2014-12-11
影响因子：
158.5
通讯作者：
Zaslavsky, Alan M.
中科院分区：
文献类型：
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作者：
Ayanian, John Z.;Landon, Bruce E.;Zaslavsky, Alan M.
背景不同种族和民族的联邦医疗保险参保人在控制血压、胆固醇和血糖方面的差异可能会导致健康结果的持续差异。方法2011年参加联邦医疗保险优势健康计划的老年参保人中，有高血压(94,171人)、心血管疾病(112,039人)或糖尿病(105,848人)，我们比较了年龄和性别调整后的比例，其中血压低于140/90 mm Hg，低密度脂蛋白胆固醇水平低于100毫克/升(2.6 mmol/升)，糖化血红蛋白值9.0%或更低。结果2006年和2011年参加研究的白人参与者在血压(两年内参与者比例的调整后绝对差异，分别为7.9个百分点和10.3个百分点)、胆固醇(分别为11.4个百分点和10.2个百分点)和糖化血红蛋白(分别为10.1个百分点和9.4个百分点)方面得到充分控制的可能性明显低于白人参与者(P
BACKGROUNDDifferences in the control of blood pressure, cholesterol, and glucose among the various racial and ethnic groups of Medicare enrollees may contribute to persistent disparities in health outcomes.METHODSAmong elderly enrollees in Medicare Advantage health plans in 2011 who had hypertension (94,171 persons), cardiovascular disease (112,039), or diabetes (105,848), we compared the respective age-and-sex-adjusted proportions with blood pressure lower than 140/90 mm Hg, low-density lipoprotein cholesterol levels below 100 mg per deciliter (2.6 mmol per liter), and a glycated hemoglobin value of 9.0% or lower, according to race or ethnic group. Comparisons were made nationally and within regions and health plans, and changes since 2006 were assessed.RESULTSBlack enrollees in 2006 and 2011 were substantially less likely than white enrollees to have adequate control of blood pressure (adjusted absolute differences in proportions of enrollees in the 2 years, 7.9 percentage points and 10.3 percentage points, respectively), cholesterol (11.4 percentage points and 10.2 percentage points, respectively), and glycated hemoglobin (10.1 percentage points and 9.4 percentage points, respectively) (P