Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

2006 HSR&D National Meeting Abstract


3018 — Lack of Racial Variation in the Use of ACE-I or ARB Therapy in Primary Care Patients with Diabetes and Hypertension

Author List:
Barnett MJ (CRIISP)
Tripp-Reimer T (CRIISP)
Rosenthal GE (CRIISP)

Objectives:
To determine if the use of angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy in patients with diabetes (DM) and hypertension (HTN) varies by race.

Methods:
Data from the VA Outpatient Care Files (OPC) and the Pharmacy Outpatient (DSS) Prescription Files were merged to identify 440,570 VA primary care patients with diabetes and hypertension during a 2-year time period (FY2002-03) for whom race was captured. Generalized estimating equations (GEE) were used to estimate the odds of receiving one or more prescriptions for ACE-I or ARB therapy, and > 6 months of therapy in black and other (Asian, Hispanic, Native American) patients, relative to whites. These analyses adjusted for age, gender, marital status, whether patients were indigent or had a service connected disability, and facility.

Results:
The study sample had a mean age of 66 ± 11 years; 97% were male. 74% (n=325,776) were white, 17% (n=77,063) were black, and 9% (n=37,731) were other races; 34% had a service connected disability and 47% were classified as indigent on the basis of VA means testing. Overall, 81% of patients received one or more prescriptions for ACE-I or ARB therapy; rates were generally similar for whites, blacks, and other races (81%, 82%, and 82%, respectively); rates were identical across race (72%, 72%, and 72%) for 6 months of therapy. In GEE analyses, the adjusted odds of 1 or more ACE-I/ARB prescriptions were similar in blacks (OR=1.03; 95% CI, 0.99-1.07; p=.08) but higher for others (OR=1.12; 95% CI, 1.06-1.18; p<.01), compared to whites. The odds of receiving 6 or more months were similar among black and others (OR=0.98; 95% CI, 0.95-1.01; p=.23 and OR=1.02; 95% CI, 0.99-1.06; p=.12).

Implications:
A large majority of VA primary care patients with DM and HTN received guideline-concordant treatment with ACE-I or ARBs. Moreover, there was no evidence of meaningful racial disparity in the utilization of these medications.

Impacts:
Given the prevalence of co-management, future work should evaluate its impact on quality in other domains of care.