Disparities In Prescribing Research Articles

Statin prescription disparities in patients with breast cancer and diabetes for primary cardiovascular disease prevention

BackgroundThis brief report examines statin prescription trends for primary cardiovascular disease (CVD) prevention in breast cancer (BC) survivors with diabetes, a large population at particularly high CVD risk.MethodsA population-based, retrospective cohort study was conducted using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims. We identified women with preexisting diabetes who were diagnosed with stage 0–III primary BC between 2008 and 2017 without preexisting CVD. We assessed statin prescription rates over time and also examined differences in statin prescription rates according to patient sociodemographic characteristics. Using a multivariate logistic regression adjusted for sociodemographic and clinical variables, independent predictors of statin prescription were identified.ResultsOf 8,423 BC patients with diabetes without preexisting CVD, 5,698 (68%) had a statin prescription. Statin prescriptions increased over time (BC diagnosis year 2008–2009: 65%, 2010–2011: 67%, 2012–2013: 66%, 2014–2015: 69%, 2016–2017: 70%; p = 0.01) and differed by age (66–69: 66%, 70–74: 70%, 75–79: 69%, ≥80: 65%; p < 0.01) and race (White: 68%, Black: 62%, Latina: 66%, Other: 72%; p < 0.01). In a multivariate analysis, race (Black vs. White: OR 0.80, 95% CI: 0.68–0.95) remained a predictor of statin prescription.ConclusionIn older early-stage BC survivors, statin prescriptions increased over time and varied by age, race, and BC stage. These findings can potentially inform strategies to improve guideline-concordant statin prescriptions in a group at high risk for CVD and reduce disparities.

Rates of buprenorphine prescribing and racial disparities among patients with opioid overdose

BackgroundAwareness of the relationship between real-world buprenorphine prescribing and overdose frequency is limited, especially in the Southeastern United States. We described buprenorphine prescribing rates for patients experiencing nonfatal opioid overdoses in the context of overdose frequency. MethodsElectronic medical records review was conducted at an urban, academic hospital in Alabama from January 1 through December 31, 2021. Patients with opioid use disorder (OUD) and nonfatal opioid overdoses, dispositioned from either the emergency department (ED), inpatient, or outpatient affiliated clinics, were identified by International Classification of Diseases-10 codes. ResultsThe study included 358 unique patients. Many patients were white (71.5%), male (59.2%), and uninsured (54.2%), with a mean age of 42.0±12.8 years. The majority (85.5%) experienced one to three overdoses, and 14.5% of patients had more than three overdoses. The buprenorphine prescription rate increased to 55.8% when patients had more than three overdoses, compared to one overdose (34.5%) and two to three overdoses (37.4%) (p=0.025). Compared to females, more males overdosed more than once (p=0.004). Black patients were less likely to receive buprenorphine prescriptions than white patients (27.3% vs. 44.5%, p=0.004). Compared to patients with multiple overdoses, more patients with one overdose had public insurance (p=0.028) and were less likely to present to the ED (p<0.001). ConclusionUnder-prescribing of buprenorphine is high among patients with OUD and opioid overdoses, even in patients with multiple overdoses, and there appear to be racial disparities in prescribing. Our findings indicate clinical opportunities for improving buprenorphine prescribing and reducing the current disparities.

Investigating socioeconomic disparities in prescribing new diabetes medication

Abstract Background There is a concern regarding socioeconomic disparities in prescription of new medications such as SGLT-2is or GLP-1RAs in type 2 diabetes mellitus (T2DM). This study aims to analyze prescription patterns of these medications and assess socioeconomic disparities in their initiation among individuals with T2DM with very high cardiovascular risk. Methods Individuals diagnosed with T2DM and very high cardiovascular risk were identified (N = 10,768) based on general practitioner’ electronic health record data. Socioeconomic status (SES) was based on standardized disposable household income in quintiles. The association between SES and the prescription of SGLT-2is and GLP-1RAs in 2022 was investigated by logistic regression analyses, adjusting for potential confounding factors. SGLT-2is and GLP-1RAs prescription patterns were examined over 2019-2022, stratified for age-groups and sex. Results We found a positive association between SES quintile 1 (referent) and quintile 4 in SGLT-2is prescription in all models (OR 1.29 95%CI:1.08-1.54 in the fully adjusted model). For prescriptions of GLP-1RAs, we found no significant differences in SES. Proportionally, men are more frequently prescribed SGLT-2is, while there are no sex disparities in GLP-1RAs prescription. Older individuals consistently receive fewer SGLT-2is and GLP-1RAs prescriptions compared to other age categories. Conclusions We observed sex and age disparities but no profound socioeconomic differences in initiation of SGLT-2is and GLP-1RAs in the Netherlands. The latter may be due to guidelines’ clear indication of the eligible population (T2DM and very high cardiovascular risk) and GP education. Future development and potential disparities in initiation and maintenance should be monitored. Key messages • We found no disparities in prescribing new Type 2 diabetes medication based on socioeconomic status. • The adoption of prescribing new medication for Type 2 diabetes patients takes time.

Racial and Ethnic Disparities in Prescription of a Novel Agent in Medical Management of Primary Open-Angle Glaucoma

ABSTRACT Purpose To investigate racial and ethnic inequalities in prescription of Netarsudil, one of two anti-glaucoma medications with a novel mechanism to be introduced in the past two decades, among patients with primary open-angle glaucoma. Methods This retrospective cohort matched study, based on electronic health records consisting of 92 million patients in the U.S, utilized Propensity Score Match, Relative Risk, Kaplan–Meier survival, and Chi-Square analysis to identify differences in rates of Netarsudil prescribing between racial and ethnic groups (non-Hispanic White, non-Hispanic Black, non-Hispanic Other Race, and Hispanic). Results Among the sample of patients that met Primary Open-Angle Glaucoma inclusion criteria (55,942), more White patients were prescribed Netarsudil than Black; (RR:1.24, 95% CI: 1.15-1.34) and Hispanic; (RR:1.63, 95% CI: 1.29-2.07) patients. White patients had higher prescription rates than Black patients in the Midwest (6.5% vs 4.2%; p < 0.0001) and West (11.2% vs 7.1%; p = 0.0002), higher rates than Hispanic patients in the South (4.9% vs. 2.0%; p < 0.0001) and West (11.2% vs. 7.8%; p < 0.008), but lower rates than Black patients in the Northeast (7.2% vs. 13.2%; p < 0.0001). Conclusions Differences in Netarsudil prescription rates within the United States exist between White and Black patients, and White and Hispanic patients. These differences exist when stratified by regions within the U.S. by varying degrees. Future studies are needed to investigate factors contributing to disparities in accessing new medications and to identify ways to eliminate such barriers to improve equity in care of glaucoma patients, especially among those historically disadvantaged.

Association of Race and Ethnicity with Prescriptions for Continuous Glucose Monitoring Systems Among a National Sample of Veterans with Diabetes on Insulin Therapy.

Introduction and Objective: Continuous glucose monitoring (CGM) can improve glycemic control in people with diabetes on insulin therapy. We assessed rates of prescriptions for CGM in a national sample of Veterans across subgroups defined by race and ethnicity. Methods: This cross-sectional analysis of data from the U.S. Veterans Health Administration included adults with type 1 or type 2 diabetes on insulin therapy. Main exposures included self-reported race and ethnicity, and primary outcome was the percentage of patients with at least one CGM prescription between January 1, 2020, and December 31, 2021. Association of race and ethnicity categories with CGM prescription was examined using multilevel, multivariable mixed-effects models. Results: Among 368,794 patients on insulin (mean age, 68.5 years; 96% male; 96.8% type 2 diabetes; 0.8% American Indian or Alaska Native, 0.7% Asian, 18.9% Black or African American, 0.9% Native Hawaiian or other Pacific Islander, 70.2% White, 2.8% multiracial, 5.7% with unknown race, and 7.0% Hispanic or Latino ethnicity), 11.2% were prescribed CGM. CGM was prescribed for 10.4% American Indian or Alaska Native, 9.7% Asian, 9.2% Black or African American, 9.3% Native Hawaiian or other Pacific Islander, 11.8% White, 11.8% multiracial, and 10.1% patients with unknown race. CGM was prescribed for 8.3% Hispanic or Latino, 11.4% non-Hispanic, and 11.5% of patients with unknown ethnicity. After accounting for patient-, clinical-, and system-level factors, Black or African American patients had significantly lower odds of CGM prescription compared with White patients (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.59-0.64), whereas Hispanic or Latino patients had significantly lower odds compared with non-Hispanic patients (aOR 0.79, 95% CI 0.74-0.84). Findings were consistent across subgroups with clinical indications for CGM use. Conclusions: Among Veterans with diabetes on insulin therapy, there were significant disparities in prescribing of CGM technology by race and ethnicity, which require further study and intervention.

Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed.

The opioid epidemic is a major cause of morbidity and mortality in the United States. Prior work has shown that emergency department (ED) opioid prescribing can increase the incidence of opioid use disorder in a dose-dependent manner, and systemic changes that decrease default quantity of discharge opioid tablets in the electronic health record (EHR) can impact prescribing practices. However, ED leadership may be interested in the impact of communication around the intervention as well as whether the intervention may differentially impact different types of clinicians (physicians, physician assistants [PA], and nurse practitioners). We implemented and evaluated a quality improvement intervention of an announced decrease in EHR default quantities of commonly prescribed opioids at a large, academic, urban, tertiary-care ED. We gathered EHR data on all ED discharges with opioid prescriptions from January 1, 2019-December 6, 2021, including chief complaint, clinician, and opioid prescription details. Data was captured and analyzed on a monthly basis throughout this time period. On March 29, 2021, we implemented an announced decrease in EHR default dispense quantities from 20 tablets to 12 tablets for commonly prescribed opioids. We measured pre- and post-intervention quantities of opioid tablets prescribed per discharge receiving opioids, distribution by patient demographics, and inter-clinician variability in prescribing behavior. The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (P = <.001). We found no statistically significant disparities in prescriptions based on self-reported patient race (P = 0.68) or gender (P = 0.65). Nurse practitioners and PAs prescribed more opioids per encounter than physicians on average and had a statistically significant decrease in opioid prescriptions associated with the EHR change. Physicians had a lesser but still significant drop in opioid prescribing in the post-intervention period. Decreasing EHR defaults is a robust, simple tool for decreasing opioid prescriptions, with potential for implementation in the 42% of EDs nationwide that have defaults exceeding the recommended 12-tablet supply. Considering significant inter-clinician variability, future interventions to decrease opioid prescriptions should examine the effects of combining EHR default changes with targeted interventions for clinician groups or individual clinicians.

Differences in schizophrenia treatments by race and ethnicity—analysis of electronic health records

Racial disparities in prescriptions of anti-psychotics have been highlighted before. However, (i) the evidence on other medications, including anti-depressant or mood stabilizing medications is lacking, and (ii) the role of potentially confounding factors and (iii) specificity of such disparities to schizophrenia (SCZ), are still unknown. We used electronic health records (EHRs) from 224,212 adults to estimate the odds ratios of receiving a prescription for different nervous system medications among patients with SCZ of different race/ethnicity, and analogous linear models to investigate differences in prescribed medication doses. To verify specificity of the observed patterns to SCZ, we conducted analogous analyses in depression and bipolar disorder (BD) patients. We found that Black/African American (AA) and Hispanic patients with SCZ were more likely to be prescribed haloperidol (Black/AA: OR = 1.52 (1.33–1.74); Hispanic: OR = 1.32 (1.12–1.55)) or risperidone (Black/AA: OR = 1.27 (1.11–1.45); Hispanic: OR = 1.40 (1.19–1.64)), but less likely to be prescribed clozapine (Black/AA: OR = 0.40 (0.33-0.49); Hispanic: OR = 0.45 (0.35-0.58)), compared to white patients. There were no race/ethnicity-related differences in the prescribed medication doses. These patterns were not specific to SCZ: Asian, Hispanic and Black/AA patients with BD or depression were more likely to be prescribed anti-psychotics, but less likely to be prescribed antidepressants or mood-stabilizers. In conclusion, we found racial/ethnic disparities in the medications prescribed to patients with SCZ and other psychiatric conditions. We discuss the potential implications for the quality of care for patients of diverse races/ethnicities.

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model.

To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. There is a need for further research on the complex, overlapping risk environments ofracial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia

Background and objectivesThe elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. MethodsThe data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. ResultsThere were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. ConclusionThe study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department’s prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.

Racial, ethnic, and biologic sex disparities in outpatient laboratory monitoring of isotretinoin use: a cross-sectional study.

Isotretinoin is commonly used for the treatment of acne. Despite high efficacy, isotretinoin has a side effect profile that prompts regular outpatient laboratory monitoring. Emerging evidence suggests clinically significant lab abnormalities are rare. Racial, ethnic, and biologic sexdisparities in laboratory monitoring of isotretinoin have yet to be characterized. This study explores disparities in laboratory monitoring of patients prescribed isotretinoin, factoring in the COVID-19 pandemic given its impacts on laboratory monitoring. Two populations were evaluated: all patients taking isotretinoin, and patients taking isotretinoin with no metabolic, cardiovascular, hematologic, hepatic, or renal comorbidities. The latter population was included to screen out patients who might receive increased laboratory testing for conditions besides isotretinoin use. Our data reveal that African-American, Asian, and Hispanic patients prescribed isotretinoin were more likely than Caucasian patients to receive orders for outpatient laboratory monitoring. These disparities persisted independent of comorbidities that may prompt additional testing, suggesting that non-Caucasian patients bear an additional testing burden even when their comorbidities were matched to their peers. Disparities persisted in the setting of reduced laboratory monitoring due to the COVID-19 pandemic. These data reveal that patients of color are more likely to receive outpatient laboratory monitoring for isotretinoin prescriptions. There is an opportunity for testing standardization to improve medication access, decrease burden and costs for patients and the healthcare system, and decrease racial disparities in prescribing and monitoring of isotretinoin. Dermatology clinics may benefit from standard operating procedures outlining for whom regular monitoring is needed.

Eligibility and prescribing rates of SGLT2 inhibitors for ambulatory patients with heart failure and reduced ejection fraction in a multidisciplinary heart failure management programme

Abstract Introduction Sodium-glucose cotransporter 2 (SGLT2) inhibitors dapagliflozin or empagliflozin are recommended, in addition to optimal medical therapy (OMT), for patients with heart failure with reduced ejection fraction (HFrEF) regardless of diabetes status.(1) Both have been licensed for use in the UK NHS by NICE,(2,3) but the proportion of 'real world' heart failure (HF) patients for whom these guidelines are applicable is unknown. For those eligible, multidisciplinary HF management programmes (HF-MPs), may enable more rapid translation of guidelines into practice.(1) Purpose We aimed to identify the patients eligible to start, and those prescribed, SGLT2 inhibitors amongst patients attending a HF-MP at a tertiary centre in the UK. We also assessed for variation by age and sex. Methods In this single-centre retrospective study we selected consecutive patients who attended a heart failure clinic appointment between 01 November 2020 - 01 March 2021. We extracted information pertaining to baseline demographics, investigations, and therapies relevant to eligibility for SGLT2 inhibitors, and prescription of SGLT2 inhibitors at baseline and 2-year follow-up. Differences in SGLT2 inhibitor prescription by age and sex were analysed using the χ2 test. All tests were two-sided, and statistical significance was considered as p value &amp;lt;0.05. Results Over this period, 296 stable chronic HF patients attended the centre. The majority of patients had HFrEF (53%),4 and there was a broad age distribution including the very elderly (28% &amp;gt; 80 years) (Table 1). Patients with HFrEF were well optimised [beta blocker (86%), angiotensin-converting enzyme/ angiotensin receptor blocker (61%), sacubitril- valsartan (23%), mineralocorticoid receptor antagonist (50%)] (Table 1). Of the whole cohort, 107 (36%) patients met eligibility for SGLT2 inhibitor prescription, with 24 (8%) already receiving a SGLT2 inhibitor at the point of guideline implementation, of whom 15 (5%) had diabetes mellitus (Figure 1). At 2-year follow-up 64 eligible individuals (22%) were prescribed a SGLT2 inhibitor, meaning that prescription amongst eligible individuals had increased from 22% to 60%, with greater improvement in younger individuals (Figure 1). Age-stratified analysis revealed that at least 30% of clinic attendees in each decile were eligible for SGLT2 inhibitors, and almost half of sexagenarian attendees (47%). Though there was not a disparity in prescription of SGLT2 inhibitors for women compared to men (51% vs 64% p=0.22), those aged ≥80 years less frequently received SGLT2 inhibitors compared with younger individuals (33% vs 69%, p&amp;lt;0.001). Conclusions Among stable HF patients in a ‘real world’ setting, a significant proportion are eligible for SGLT2 inhibitors. Patients attending a HF-MP have benefitted from early implementation of novel guidelines, though there are age-determined gaps in SGLT2 inhibitor prescription that represent an actionable target.Table 1Figure 1

Race, economic status, and disparities in the receipt of benzodiazepine prescriptions in a large primary care sample

ObjectiveTo evaluate the relationship between race, economic status, and patient characteristics with benzodiazepine prescribing in an urban and suburban primary care context. MethodThis retrospective study used data from a previously described cohort of patients seen in a large Ohio healthcare system's primary care clinics from 2019 to 2020. Associations and interactions between race, economic status (using median income of patient ZIP code as a proxy), patient characteristics, and prescription of benzodiazepines were assessed using multivariable logistic regression. Results455,537 patients had 1,643,473 primary care visits, and 5.8% of patients were prescribed a benzodiazepine. White patients were prescribed benzodiazepines more often than Multiracial/Multicultural, African American and Asian American patients (6.5%, 3.8%, 2.7% and 2.0% respectively). Patients from lower income ZIP codes were less likely to receive a prescription. Interaction effects were observed between race, patient economic status, gender, insurance status, and diagnoses (general anxiety disorder, insomnia, and panic disorder). The largest prescribing disparities by race were among patients with these three diagnoses. The largest disparity in prescription by income was seen in African American patients. ConclusionAfrican American, Multicultural/Multiracial and Asian American patients were less likely than White patients to receive benzodiazepine prescriptions. Middle and lower-income patients are particularly susceptible to this prescribing disparity.

Pronounced State-Level Disparities in Prescription of Cannabinoids to Medicaid Patients

Introduction: Dronabinol is approved in the USA for chemotherapy-induced nausea as well as vomiting and HIV-induced anorexia, while cannabidiol is primarily approved for childhood epileptic disorders Lennox-Gastaut and Dravet syndrome. The use pattern for these prescription cannabinoids in the USA is unknown. This study examined Medicaid claims for two FDA-approved prescription cannabinoids, dronabinol and cannabidiol, approved in 1985 and 2018, respectively, from 2016–2020 to better understand the pharmacoepidemiologic trends and distribution of these drugs in US Medicaid amidst the increasing use of non-pharmaceutical formulations of cannabis. Methods: The longitudinal study analyzed Medicaid prescription claims that were calculated by extracting the prescriptions on a state level from 2016 to 2020 for two cannabinoids, dronabinol and cannabidiol, where outcomes over each year were calculated. Outcomes were (1) the number of prescriptions for each state corrected for the number of Medicaid enrollees and (2) dronabinol and cannabidiol spending. Spending refers to the amount reimbursed by the state Medicaid program. Results: Dronabinol prescriptions per state decreased by 25.3% from 2016 to 2020, while cannabidiol prescriptions increased by 16,272.99% from 2018 to 2020. The spending on these drugs parallels that of their prescription trend with a 66.3% decrease in reimbursement for dronabinol ($5.7 million in 2020), whereas cannabidiol increased by +26,582.0% ($233.3 million in 2020). Dronabinol prescriptions, when corrected for the number of enrollees, in Connecticut were 136.4 times larger than in New Mexico, and seventeen states had zero prescriptions. Idaho’s prescriptions of cannabidiol (27.8/10,000 enrollees) were significantly elevated relative to the national average and were 15.4-fold higher than Washington, DC (1.8/10K enrollees). Conclusions: The prescriptions of pharmaceutical-grade tetrahydrocannabinol decreased while those of cannabidiol increased. This study also identified pronounced state-level variation in cannabinoid prescribing to Medicaid patients. State formularies and prescription drug list variation may contribute to the drug reimbursements in Medicaid, though further research is needed to identify the health policy or pharmacoeconomic origins of these disparities.

CO139 A Retrospective Study of Sglt-2 Inhibitors Prescription Disparities and Affordability Among Medicare Patients with Diabetes

Despite being covered by Medicare Part D and commercial insurance plans, adoption of SGLT-2 inhibitors has been slower among Black and female patients compared to their White and male counterparts. Additionally, Medicare beneficiaries tend to have lower usage rates compared to those with commercial insurance. This study aims to examine inequalities in SGLT-2 inhibitor use among Medicare patients with type 2 diabetes (T2D), based on demographic and socioeconomic factors and how these factors affect overall Medicare spending.

Disparities in statin prescription among patients with severe hypercholesterolemia in an integrated healthcare system

BackgroundSevere hypercholesterolemia (SH), defined as a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dl, is associated with an increased risk for premature atherosclerotic cardiovascular disease. Despite guideline recommendations, many patients with severe hypercholesterolemia remain untreated. We conducted an observational analysis of a large pool of SH patients, exploring demographic and social factors contributing to disparities in the prescription of statin and other lipid-lowering therapies. MethodsWe included all adults (age 18 or older) in the University Hospitals Health Care System, with an LDL-C ≥ 190 mg/dl on a lipid profile drawn between January 2, 2014, and March 15, 2022. Variables were compared across relevant categories of age, gender, race and ethnicity, medical history, prescription medication status, insurance type, and provider referral type. We used the Fischer exact test and Pearson Chi-square (χ 2) for variable comparisons. ResultsA total of 7,942 patients were included in the study. The median age was 57 [IQR 48–66] years with 64% female, and 17% Black patients. Only 58% of the total cohort was prescribed statin therapy. Higher age was independently associated with a higher likelihood of receiving a statin, with an odds ratio of 1.25 (95% CI [1.21 – 1.30] per 10 years, p<0.001). Additional factors that were associated with higher rates of statin prescription in patients with SH were Black race (OR 1.90, 95% CI [1.65 – 2.17], p<0.001), smoking (OR 2.42, 95% CI [2.17 -2.70], p<0.001), and presence of diabetes (OR 3.88, 95% CI [3.27 – 4.60], p<0.001). Similar trends were also seen with other lipid-lowering therapies such as ezetimibe and fibrates. ConclusionsIn our Northeast Ohio healthcare system, less than two-thirds of patients with severe hypercholesterolemia are prescribed a statin. Statin prescription rates were highly dependent on age and the presence of additional ASCVD risk factors.

Patterns and disparities in prescribing of opioids and benzodiazepines for older adults in North Carolina.

We characterized real-world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of co-prescribing. A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n=25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co-prescribing. We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non-White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co-prescribing was observed among 15% of opioid users and 13% of BZD users. Co-prescribing was largely driven by the presence of relevant co-morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics. We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.

Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose

IntroductionPatients who initially survive opioid-related overdose are at high risk for subsequent mortality. Our health system aimed to evaluate the presence of disparities in prescribing naloxone following opioid overdose. MethodsThis was a retrospective cohort study of patients seen in our health system, which comprises two academic centers and eight community hospitals. Eligible patients had at least one visit to any of our hospital's emergency departments (EDs) with a diagnosis code indicating opioid-related overdose between May 1, 2018, and April 30, 2021. The primary outcome measure was prescription of nasal naloxone after at least one visit for opioid-related overdose during the study period. ResultsThe health system had 1348 unique patients who presented 1593 times to at least one of the EDs with opioid overdose. Of included patients, 580 (43.2%) received one or more prescriptions for naloxone. The majority (68.9%, n = 925) were male. For race/ethnicity, 74.5% (1000) were Non-Hispanic White, 8.0% (n = 108) were Non-Hispanic Black, and 13.0% (n = 175) were Hispanic/Latinx. Compared with the reference age group of 16–24 years, only those 65+ were less likely to receive naloxone (adjusted odds ratio [aOR] 0.41, 95% confidence interval [CI] 0.20–0.84). The study found no difference for gender (male aOR 1.23, 95% CI 0.97–1.57 compared to female). Hispanic/Latinx patients were more likely to receive a prescription when compared to Non-Hispanic White patients (aOR 1.72, 95% CI 1.22–2.44), while no difference occurred between Non-Hispanic Black compared to Non-Hispanic White patients (aOR 1.31, 95% CI 0.87–1.98). ConclusionsNaloxone prescribing after overdose in our system was suboptimal, with fewer than half of patients with an overdose diagnosis code receiving this lifesaving and evidence-based intervention. Patients who were Hispanic/Latinx were more likely to receive naloxone than other race and ethnicity groups, and patients who were older were less likely to receive it. Health systems need ongoing equity-informed implementation of programs to expand access to naloxone to all patients at risk.

Racial Disparities in Prescription of Antidepressants Among U.S. Veterans Referred to Behavioral Health Care.

Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is warranted. This study examined the association between race and prescription of antidepressants among veterans in primary care. Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a collaborative care program completed an assessment of demographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships between patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines. White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75–2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescription of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40–2.50, p<0.001). The findings reveal racial disparities in antidepressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recommended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.

Global disparities in prescription of guideline-recommended drugs for heart failure with reduced ejection fraction.

Heart failure (HF) is a global challenge, with lower- and middle-income countries (LMICs) carrying a large share of the burden. Treatment for HF with reduced ejection fraction (HFrEF) improves survival but is often underused. Economic factors might have an important effect on the use of medicines. This analysis assessed prescription rates and doses of renin-angiotensin system (RAS) inhibitors, β-blockers, and mineralocorticoid receptor antagonists at discharge and 6-month follow-up in 8669 patients with HFrEF (1458 from low-, 3363 from middle-, and 3848 from high-income countries) hospitalized for acute HF in 44 countries in the prospective REPORT-HF study. We investigated determinants of guideline-recommended treatments and their association with 1-year mortality, correcting for treatment indication bias.Only 37% of patients at discharge and 34% of survivors at 6 months were on all three medication classes, with lower proportions in LMICs than high-income countries (19 vs. 41% at discharge and 15 vs. 37% at 6 months). Women and patients without health insurance, or from LMICs, or without a scheduled medical follow-up within 6 months of discharge were least likely to be on guideline-recommended medical therapy at target doses, independent of confounders. Being on ≥50% of guideline-recommended doses of RAS inhibitors, and β-blockers were independently associated with better 1-year survival, regardless of country income level. Patients with HFrEF in LMICs are less likely to receive guideline-recommended drugs at target doses. Improved access to medications and medical care could reduce international disparities in outcome.

MP17-20 RACIAL DISPARITIES IN PRESCRIPTION EXPENDITURES AND NUMBER OF PRESCRIPTIONS FOR COMMON BENIGN UROLOGIC CONDITIONS

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-20 RACIAL DISPARITIES IN PRESCRIPTION EXPENDITURES AND NUMBER OF PRESCRIPTIONS FOR COMMON BENIGN UROLOGIC CONDITIONS Michael Rezaee, Charlotte Ward, and Martin Gross Michael RezaeeMichael Rezaee More articles by this author , Charlotte WardCharlotte Ward More articles by this author , and Martin GrossMartin Gross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial disparities in healthcare delivery have been described for many medical conditions in the United States. Little is known about potential racial disparities in the medications prescribed to urology patients. We sought to identify potential racial disparities in prescription expenditures and number of medications prescribed in persons treated for common benign urologic conditions. METHODS: A retrospective secondary data analysis was conducted of adult survey respondents treated for common benign urologic conditions using 2016-2018 Medical Expenditure Panel Survey (MEPS) data. MEPS is a nationally representative survey of US civilian noninstitutionalized persons. Benign conditions of interest included: urolithiasis, erectile dysfunction (ED), cystitis, urinary incontinence (UI), and benign prostate hyperplasia (BPH). Generalized linear regression was used to evaluate the relationship between mean prescription expenditures and number of prescriptions and race for each condition. Race was categorized as white versus non-white. Adjusted analyses accounted for age, sex, number of chronic conditions, poverty status, self-reported health status, marital status, highest degree of educational attainment, and insurance status. RESULTS: The weighted analysis groups consisted of 4,762,781 persons with urolithiasis, 1,389,547 with ED, 4,643,764 with cystitis, 4,907,138 with UI, and 7,763,307 with BPH. Mean prescription expenditures were greater for white persons for all benign urologic conditions. After adjustment, white race was associated with significantly higher mean prescription expenditures among persons treated for ED (β=1.1, 95% CI: 0.22-1.96) and cystitis (β=0.80, 95% CI: 0.02-1.57). With the exception of ED, mean number of prescriptions was greater for white persons with urolithiasis, cystitis, UI, and BPH. After adjustment, white race was associated with a significantly greater mean number of prescriptions for persons treated for BPH (β=0.24, 95% CI: 0.05-0.44). CONCLUSIONS: Prescription expenditures are significantly higher for persons of white race treated for ED and cystitis in the United States. This may suggest that more costly ED and cystitis medications are prescribed to whites compared to non-whites. Furthermore, the number of BPH prescriptions is greater for whites than non-whites, but expenditures are similar. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e316-e316 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Charlotte Ward More articles by this author Martin Gross More articles by this author Expand All Advertisement Loading ...