Impact of Medicare Part D on Racial Disparities in Diabetes Treatment and Outcome

医疗保险 D 部分对糖尿病治疗和结果中种族差异的影响

• 批准号: 7938793
• 负责人: JULIE Marie DONOHUE
• 金额: $ 23.27万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938793
• 关键词: Impact; Medicare; Part; Racial; Disparities

DESCRIPTION (provided by applicant): Many older adults respond to high out-of-pocket drug costs by skipping, reducing dosages of or not filling prescriptions for their medications. A primary goal of the new Medicare drug benefit (Part D) was to increase the availability of drug coverage and thereby improve medication use among older adults. Medicare Part D may have a disproportionate impact on medication use among beneficiaries in minority groups. For instance, African American beneficiaries have enrolled in Part D in greater numbers (62% vs. 48%) than Caucasian beneficiaries. Moreover, African American beneficiaries are more likely than Caucasian beneficiaries to qualify for generous Part D low-income subsidies. As a result, Part D may help to alleviate racial/ethnic disparities in clinical processes of care and health outcomes that have been documented for a range of chronic conditions among older adults. We will assess the impact of Part D on racial disparities in medication use and health outcomes for older adults with diabetes, a chronic condition with increasing prevalence. Given the worse glycemic control and higher diabetes-related mortality among African Americans compared to Caucasians, our proposed investigations have critical implications for health disparities. The long-term objective of our proposed study is to reduce racial/ethnic disparities in health by examining the impact of changes in insurance coverage among the elderly. This proposal has two primary objectives. First, we will assess racial differences in antidiabetic medication use, glycemic control, and diabetes-related hospitalizations and mortality for an elderly cohort with diabetes before the implementation of Part D. We hypothesize that older African American beneficiaries with diabetes will have lower levels of antidiabetic medication use, worse glycemic control, and higher diabetes-related hospitalization and mortality rates compared to Caucasian beneficiaries. Second, we will examine whether Part D mitigates racial disparities in medication use, glycemic control, and diabetes-related hospitalizations and mortality in the elderly. We hypothesize that older African Americans compared to Caucasians will experience a larger improvement in medication use, glycemic control, and diabetes-related hospitalizations and mortality. Our study will use longitudinal data from an 11-year, Medicare population-based prospective cohort study. We will adjust our estimates of the effect of race and Part D for socioeconomic status, comorbidities, health, functional and cognitive status, access to care, and other factors. Our research has important policy implications. Medicare Part D -- the most substantial expansion of insurance benefits to older adults since the program's inception over 40 years ago -- is projected to cost just under $1 trillion between 2007 and 2017. If Medicare Part D reduces racial disparities in medication access, our study will inform other efforts to expand insurance coverage to vulnerable populations. Our multidisciplinary research team has extensive experience conducting health policy analyses, pharmacoepidemiologic studies with geriatric populations, health disparities and diabetes research, and is uniquely positioned to shed light on this critical policy issue.

描述（由申请人提供）：许多老年人通过跳过药物、减少剂量或不按处方配药来应对高昂的自付费用。新医疗保险药物福利（D 部分）的主要目标是增加药物覆盖范围，从而改善老年人的药物使用。医疗保险 D 部分可能对少数群体受益人的药物使用产生不成比例的影响。例如，非洲裔美国受益人参加 D 部分的人数（62% 比 48%）多于白人受益人。此外，非洲裔美国受益人比​​白人受益人更有可能有资格获得慷慨的 D 部分低收入补贴。因此，D 部分可能有助于缓解一系列慢性病的临床护理过程和健康结果中的种族/民族差异 在老年人中。我们将评估 D 部分对老年糖尿病患者用药和健康结果的种族差异的影响，糖尿病是一种患病率不断上升的慢性疾病。鉴于与白种人相比，非裔美国人的血糖控制更差，糖尿病相关死亡率更高，我们提出的调查对健康差异具有重要影响。我们提出的研究的长期目标是通过研究老年人保险范围变化的影响来减少健康方面的种族/民族差异。该提案有两个主要目标。首先，我们将在实施 D 部分之前评估老年糖尿病患者在抗糖尿病药物使用、血糖控制以及糖尿病相关住院和死亡率方面的种族差异。我们假设患有糖尿病的老年非洲裔美国受益人的抗糖尿病水平较低与白人受益人相比，药物使用、血糖控制较差以及与糖尿病相关的住院率和死亡率较高。其次，我们将研究 D 部分是否可以减轻老年人在药物使用、血糖控制以及糖尿病相关住院和死亡率方面的种族差异。我们假设，与白人相比，老年非洲裔美国人在药物使用、血糖控制以及糖尿病相关住院率和死亡率方面将有更大的改善。我们的研究将使用一项为期 11 年、基于医疗保险人群的前瞻性队列研究的纵向数据。我们将根据社会经济状况、合并症、健康、功能和认知状态、获得护理的机会以及其他因素调整对种族和 D 部分影响的估计。我们的研究具有重要的政策意义。医疗保险 D 部分是自 40 多年前该计划启动以来对老年人保险福利最大幅度的扩展，预计 2007 年至 2017 年间的费用将接近 1 万亿美元。如果医疗保险 D 部分减少了药物获取方面的种族差异，我们的研究将为扩大弱势群体保险覆盖范围的其他努力提供信息。我们的多学科研究团队在进行卫生政策分析、老年人群药物流行病学研究、健康差异和糖尿病研究方面拥有丰富的经验，并且具有独特的优势来阐明这一关键的政策问题。