Racial Disparities in Older Adults: Impact of Medicare Part D

描述(申请人提供)：与老年高加索人相比，高血压和缺血性心脏病(IHD，包括有心肌梗死病史或相当于风险的糖尿病)在老年非裔美国人中更常见，也更有可能得不到足够的控制。导致这些种族差异的一个关键途径是，与高加索人相比，老年非裔美国人的药物不依从性成本更高。2006年1月开始的联邦医疗保险D部分为参保者提供药品福利。这一卫生政策干预对药物使用和控制高血压和缺血性心脏病等慢性病方面的种族差异的影响尚不清楚。我们建议的研究的长期目标是通过检查这一政策干预的影响来减少健康结果中的种族差异，这一政策干预增加了老年人的处方药覆盖面。使用纵向设计，我们将检查两个目标。目标1是确定Medicare Part D药品福利干预措施对高血压患者使用降压药物的种族差异和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。需要检验的一个具体假设是，在联邦医疗保险D部分实施后，这一高危群体中的老年非洲裔美国人将比老年高加索人接受更强烈的降压治疗。需要检验的第二个具体假设是，在实施联邦医疗保险D部分后，这些高危群体中的高加索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缩小。目的2是确定Medicare Part D药品福利干预对控制高血压和IHD的种族差异的影响。需要检验的一个具体假设是，在实施联邦医疗保险D部分后，患有高血压的高加索人和非裔美国老年人之间的不受控制的血压差异将会缩小。需要检验的第二个具体假设是，在实施联邦医疗保险D部分后，患有IHD的高加索人和非裔美国老年人之间的不受控制的血脂水平的差异将会缩小。这项研究利用了正在进行的基于国家老龄化研究所(NIA)资助的11年医疗保险人口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进行卫生政策分析、老年人口药物流行病学研究、健康差距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得天独厚的优势。此外，我们拟议的研究是对PAR 07-379中概述的三个研究行动领域(公共政策)之一的响应，标题为“了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部分干预措施对减少健康差距的有效性。这项研究也符合国家老龄研究所行为和社会研究计划的健康差距倡议的利益。公共卫生相关性：获得药物治疗和遵守慢性病指南都被列入医疗保险和医疗补助服务中心(CMS)最近发布的题为“老年人的证据优先事项”的清单。这份清单提供了存在重大知识空白的临床研究主题。如果联邦医疗保险D部分通过增加用药机会来减少种族差异，从而更好地控制高血压和IHD，那么我们的研究将为其他将保险覆盖范围扩大到其他弱势人群的倡议提供参考。

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.