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Health Services Research & Development

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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)

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.

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.

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).

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.

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

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