Racial Disparities in Older Adults: Impact of Medicare Part D

描述（由申请人提供）：与老年白种人相比，高血压和缺血性心脏病（IHD，包括那些有心肌梗死[MI]或其风险相当的糖尿病病史的人）在老年非洲裔美国人中更常见，更容易得到充分控制。造成这些种族差异的一个关键途径是，与白种人相比，老年非洲裔美国人与药物依从性相关的成本更高。2006年1月开始的医疗保险D部分为登记的人提供药品福利。这种卫生政策干预对药物使用和慢性疾病（如高血压和缺血性心脏病）控制中的种族差异的影响尚不清楚。我们提出的研究的长期目标是通过检查增加老年人处方药覆盖率的政策干预的影响来减少健康结果的种族差异。使用纵向设计，我们将检查两个目标。目的1是确定医疗保险D部分药物福利干预对高血压患者使用降压药物和IHD患者（即有心肌梗死和/或糖尿病病史的患者）使用降脂药物的种族差异的影响。一个需要检验的具体假设是，在医疗保险D部分实施后，这一高风险群体中的老年非洲裔美国人将比老年白种人接受更强烈的抗高血压治疗。第二个需要检验的具体假设是，在医疗保险D部分实施后，这些高风险群体中白人和非裔美国老年人在任何降脂药物使用方面的差异将会减少。目的2是确定医疗保险D部分药物福利干预对高血压和IHD控制中的种族差异的影响。需要验证的一个具体假设是，在医疗保险D部分实施后，患有高血压的白种人和非裔美国老年人之间不受控制的血压差异将会减少。第二个需要检验的具体假设是，在医疗保险D部分实施后，患有IHD的白种人和非裔美国老年人之间不受控制的脂质水平的差异将会减少。这项研究利用了美国国家老龄化研究所（NIA）资助的持续11年的基于医疗保险人口的健康老龄化和身体成分研究的纵向数据。我们的多学科研究团队在卫生政策分析、老年人群药物流行病学研究、健康差异和心血管疾病研究方面拥有丰富的经验，在阐明这一关键政策问题方面具有独特的优势。此外，我们提出的研究是对PAR 07-379中概述的三个研究行动领域（公共政策）之一的回应，题为“理解和减少健康差距的行为和社会科学研究”，并将阐明医疗保险D部分干预措施在减少健康差距方面的有效性。这项研究也符合国家老年行为和社会研究研究所的健康差异倡议。公共卫生相关性：药物治疗的可及性和慢性病指南的依从性都被纳入医疗保险和医疗补助服务中心（CMS）最近发布的题为“老年人口的证据优先事项”的清单。此列表提供了存在重大知识空白的临床研究主题。如果医疗保险D部分通过增加药物使用的可及性来减少种族差异，从而更好地控制高血压和IHD，那么我们的研究将为将保险覆盖范围扩大到其他弱势群体的其他举措提供信息。

DESCRIPTION (provided by applicant): Both hypertension and ischemic heart disease (IHD which includes those with a history of myocardial infarction [MI] or it's risk equivalent diabetes) are more common and more likely to be inadequately controlled in older African Americans when compared to older Caucasians. One key pathway to these racial disparities is greater cost related medication non adherence in older African Americans when compared to Caucasians. Medicare Part D which began January 2006 provides a drug benefit for those enrolled. The impact of this health policy intervention on racial disparities in medication use and control of chronic diseases such as hypertension and ischemic heart disease is unknown. The long-term objective of our proposed study is to reduce racial disparities in health outcomes by examining the impact of this policy intervention of increasing prescription drug coverage among the elderly. Using a longitudinal design we will examine two objectives. Objective 1 is to determine the impact of the Medicare Part D drug benefit intervention on racial differences in the use of antihypertensive medications in those with hypertension and the use of lipid lowering medications in those with IHD (i.e., those with a history of MI and/or diabetes. One specific hypothesis to be tested is that after the Medicare Part D implementation, older Africans Americans in this high risk group will receive more intense antihypertensive regimens than older Caucasians. A second specific hypothesis to be tested is that the disparity in any lipid lowering medication use between Caucasian and African American older adults in these high risk groups will be reduced after Medicare Part D implementation. Objective 2 is to determine the impact of the Medicare Part D drug benefit intervention on racial disparities in the control of hypertension and IHD. One specific hypothesis to be tested is that the disparity in uncontrolled blood pressure between Caucasian and African American older adults with hypertension will be reduced after Medicare Part D implementation. A second specific hypothesis to be tested is that the disparity in uncontrolled lipid levels between Caucasian and African American older adults with IHD will be reduced after Medicare Part D implementation. This study capitalizes on longitudinal data from the ongoing 11 year Medicare population based National Institute on Aging (NIA) funded Health Aging and Body Composition Study. Our multidisciplinary research team has extensive experience conducting health policy analyses, pharmaco-epidemiological studies with geriatric populations, health disparities and cardiovascular disease research and is uniquely positioned to shed light on this critical policy issue. Moreover, our proposed research is responsive to one of the three research action areas (public policy) outlined in PAR 07-379 entitled "Behavioral and Social Science Research on Understanding and Reducing Health Disparities" and will shed light upon the effectiveness of the Medicare Part D intervention to reduce health disparities. This study is also consistent with the interests of the National Institute on Aging's Behavioral and Social Research Program's Health Disparities Initiatives. PUBLIC HEALTH RELEVANCE: Both access to drug therapy treatment and chronic disease guideline adherence are included as part of the recently released list by Centers for Medicare and Medicaid Services (CMS) entitled "Evidentiary Priorities for the Elderly Population". This list provides clinical research topics for which there are significant knowledge gaps. If Medicare Part D reduces racial disparities by increasing access to medication use which leads to better control of hypertension and IHD, then our study will inform other initiatives to expand insurance coverage to other vulnerable populations.