Gender disparities in lipid-lowering therapy among veterans with diabetes.

Vimalananda VG, Miller DR, Palnati M, Christiansen CL, Fincke BG. Gender disparities in lipid-lowering therapy among veterans with diabetes. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S176-81.

Related HSR&D Project(s)

• IIR 06-091 – Summary Measures of Quality for Diabetes Care

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Abstract:

PURPOSE: We sought to compare lipid-lowering therapy among female and male veterans with diabetes and hyperlipidemia. METHODS: We conducted a cross-sectional study of veterans serviced by the Veterans Health Administration in 2006 who had both diabetes and hyperlipidemia and compared all female patients to age- and facility-matched males. We compared proportions of patients with any prescription for lipid-lowering therapy in the year and, among those with elevated low-density lipoprotein cholesterol (LDL > 100 mg/dL) and no prior treatment, we compared initiation of lipid-lowering therapy. We used multiple logistic regression to estimate odds ratios (AOR) and 95% confidence intervals (CI), adjusting for race, VA eligibility, health care utilization, cardiovascular diseases, mental health conditions, and a comprehensive list of other comorbidities. We also performed the analysis stratified by age. FINDINGS: Women had higher LDL levels than men (110 38 vs. 101 36 mg/dL) and were less likely to be receiving lipid-lowering therapy (80% vs. 84%; AOR, 0.79; 95% CI, 0.76-0.82) or to be initiated on such therapy (37% vs. 42%; AOR, 0.82; 95% CI, 0.74-0.90). Differences were greatest in the youngest women ( < 45 years old) for both any lipid-lowering therapy (61% vs. 75%; AOR, 0.50; 95% CI, 0.45-0.56) and initiation of therapy (26% vs. 38%; AOR, 0.55; 95% CI, 0.42-0.73). Adjustment for potential confounders did not change the risk estimates. CONCLUSION: Women veterans with diabetes and hyperlipidemia receive less aggressive lipid-lowering therapy than men, especially among younger age groups. This disparity is of concern, because early intervention to control hyperlipidemia can reduce the later burden of cardiovascular disease among diabetic women.