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Variations in the Prescribing Patterns of Statins for Persons Diagnosed with Dyslipidemia and CHD


Charlie Link


Simon Condliffe, Charles Link

Chair: Melayne McInnes; Discussant: TBA Mon June 5, 2006 17:15-18:45 Room 121

Rationale: Events arising from coronary heart disease (CHD) are the most frequent cause of death in the US. While the onset of this condition occurs naturally with age, the identification of high cholesterol as a risk factor for CHD has prompted implementation of prevention programs, with drug therapies playing a large role. The introduction of statins in the early 1990s has provided a new and more effective treatment for lowering levels of low-density lipoproteins. Statins are promising in terms of prevention of CHD. As studies have shown for many drugs, large disparities exist across insurance types, regions of the country, and various demographic characteristics in terms of whether a patient is receiving the line of treatment recommended by clinical guidelines. That this may be the case for statins is disheartening since the technology not only exists to combat CHD through both primary and secondary prevention but also that statins are an effective treatment for all segments of the population.

Objectives: The objective of the paper is to estimate, using multinomial logit models, the prescribing patterns for statins among two groups of people, those diagnosed with CHD and dyslipidemia respectively (separate equations for each group for each of the 3 data sets). The question: Do the above-mentioned disparities exist with statins? Three databases provide several thousand observations with a host of socioeconomic and demographic information along with diagnosis information including secondary diagnoses. The first two data sets are obtained from office-based physician files (the National Ambulatory Medical Care Surveys (NAMCS)) and hospital settings (the National Hospital Ambulatory Medical Care Surveys (NHAMCS)) and provide 11 years of data, 1992 - 2002. We are in the process of running the analyses for 1996 through 2002 using the Medical Expenditure Panel Survey (MEPS). In addition to being a panel, an advantage of MEPS is that it has much richer socioeconomic data about each respondent.

Results based on NAMCS and NHAMCS: In separate samples of patients with dyslipidemia and with CHD, variations were identified across minorities, particularly for Blacks and, more drastically, regions of the US. While at times directions and magnitudes of these variations differ across data sets and medical conditions, it is evident that variations do exist. Hispanics are less likely to receive statins by 12 to 15 percent, and blacks with CHD at physicians’ offices are 7 percent less likely to receive statins. Patients may be up to 17 percent less likely to receive statins if living outside the Northeast. Medicaid patients are less likely to receive statins. Finally, as time passes patients are more likely to receive a statin, with a yearly increase of 1-5 percent.

We are currently conducting the analyses for 1996 through 2002 for the MEPS data and these will be incorporated into the paper.


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