Racial disparities in lipid control in patients with diabetes

Am J Manag Care. 2012 Jun;18(6):303-11.

Abstract

Objectives: To describe lipid management over time in a cohort of insured patients with diabetes and evaluate differences between African American and white patients.

Study design: Automated claims data were used to identify a cohort of 11,411 patients with diabetes in 1997 to 1998. Patients were followed through 2007.

Methods: Rates of hypercholesterolemia testing, treatment, and goal attainment were measured annually. Treatment was determined by a claim for lipid-lowering agents, and goal attainment was defined as a low-density lipoprotein cholesterol (LDL-C) level <100 mg/dL.

Results: During the study period, LDL-C testing increased from 48% to 70% among African American patients and from 61% to 77% among white patients. Treatment with lipid-lowering drugs increased from 23% to 56% among African American patients and 33% to 61% among white patients. The proportion at goal increased from 35% to 76% and from 24% to 59% among white and African American patients, respectively. African American patients were less likely to be tested for LDL-C (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.73-0.86), treated with lipidlowering agents (OR 0.72; 95% CI 0.65-0.80), have their medication dosage altered (OR 0.65; 95% CI 0.59-0.73), or attain LDL-C goal (OR 0.59; 95% CI 0.56-0.63) compared with white patients.

Conclusions: Although rates of LDL-C testing, treatment, and goal attainment improved over time, racial disparities in dyslipidemia management continued to exist. Further studies to determine the causes of differences in management by race are warranted.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data
  • Cholesterol, LDL / blood
  • Confidence Intervals
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Disease Management
  • Health Status Disparities*
  • Humans
  • Hyperlipidemias / blood
  • Hyperlipidemias / drug therapy
  • Hyperlipidemias / ethnology*
  • Hypoglycemic Agents / therapeutic use
  • Hypolipidemic Agents / therapeutic use
  • Insurance Claim Review
  • Lipids / blood*
  • Medication Adherence
  • Multivariate Analysis
  • Odds Ratio
  • United States / epidemiology

Substances

  • Cholesterol, LDL
  • Hypoglycemic Agents
  • Hypolipidemic Agents
  • Lipids