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Race/Ethnicity, Disability, and Medication Adherence Among Medicare Beneficiaries with Heart Failure

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A Capsule Commentary to this article was published on 31 January 2014

ABSTRACT

BACKGROUND

Recent and national data on adherence to heart failure drugs are limited, particularly among the disabled and some small minority groups, such as Native Americans and Hispanics.

OBJECTIVE

We compare medication adherence among Medicare patients with heart failure, by disability status, race/ethnicity, and income.

DESIGN

Observational study.

SETTING

US Medicare Parts A, B, and D data, 5 % random sample, 2007–2009.

PARTICIPANTS

149,893 elderly Medicare beneficiaries and 21,204 disabled non-elderly beneficiaries.

MAIN MEASURES

We examined 5 % of Medicare fee-for-service beneficiaries with heart failure in 2007–2009. The main outcome was 1-year adherence to one of three therapeutic classes: β-blockers, diuretics, and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs). Adherence was defined as having prescriptions in possession for ≥ 75 % of days.

KEY RESULTS

Among aged beneficiaries, 1-year adherences to at least one heart failure drug were 63 %, 57 %, 53 %, 50 %, and 52 % for Whites, Asians, Hispanics, Native Americans and Blacks, respectively; among the disabled, 1-year adherence was worse for each group: 57 %, 53 %, 48 %, 44 % and 43 % respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location and health status. Patterns of adherence were similar among beneficiaries on all three therapeutic classes. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to Whites, OR = 0.61 (95 % CI 0.58–0.64) for Hispanics, OR = 0.59 (95 % CI 0.57–0.62) for Blacks and OR = 0.57 (95 % CI 0.47–0.68) for Native Americans.

CONCLUSION

After the implementation of Medicare Part D, adherence to heart failure drugs remains problematic, especially among disabled and minority beneficiaries, including Native Americans, Blacks, and Hispanics. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.

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Acknowledgements

We gratefully acknowledge funding from the Institute of Medicine, National Institute of Mental Health (No. RC1 MH088510) and Agency for Healthcare Research and Quality (No. R01 HS018657) to Dr. Zhang.

Role of the Sponsor

Sponsors played no role in the study conduct, data analysis, or report generation.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Yuting Zhang PhD & Seo Hyon Baik PhD

Authors
  1. Yuting Zhang PhD
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  2. Seo Hyon Baik PhD
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Corresponding author

Correspondence to Yuting Zhang PhD.

Appendix

Appendix

Table 4 Definition for Heart Failure
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Zhang, Y., Baik, S.H. Race/Ethnicity, Disability, and Medication Adherence Among Medicare Beneficiaries with Heart Failure. J GEN INTERN MED 29, 602–607 (2014). https://doi.org/10.1007/s11606-013-2692-x

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