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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG034056-02
Application #
7926962
Study Section
Special Emphasis Panel (ZRG1-RPHB-K (50))
Program Officer
Baker, Colin S
Project Start
2009-09-15
Project End
2012-08-31
Budget Start
2010-09-01
Budget End
2012-08-31
Support Year
2
Fiscal Year
2010
Total Cost
$223,905
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
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Hanlon, Joseph T; Boudreau, Robert M; Perera, Subashan et al. (2013) Racial differences in antilipemic use and lipid control in high-risk older adults: post-Medicare Part D. Am Heart J 166:792-7
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Lo-Ciganic, Wei-Hsuan; Boudreau, Robert M; Gray, Shelly L et al. (2013) Changes in cholesterol-lowering medications use over a decade in community-dwelling older adults. Ann Pharmacother 47:984-92
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Marcum, Zachary A; Zheng, Yan; Perera, Subashan et al. (2013) Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Res Social Adm Pharm 9:817-27
Marcum, Zachary A; Hanlon, Joseph T (2012) Commentary on the new American Geriatric Society Beers criteria for potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother 10:151-9
Boyce, Richard D; Hanlon, Joseph T; Karp, Jordan F et al. (2012) A review of the effectiveness of antidepressant medications for depressed nursing home residents. J Am Med Dir Assoc 13:326-31

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