Barriers in utilizing lipid-lowering agents in non-institutionalized population in the U.S.: Application of a theoretical framework

Cardiovascular diseases are a major cause of death globally. Epidemiological evidence has linked elevated levels of blood cholesterol with the risk of coronary heart disease. However, lipid-lowering agents, despite their importance for primary prevention, are significantly underused in the United States. The objective of this study was to explore associations among socioeconomic factors and the use of antihyperlipidemic agents in 2018 in U.S. patients with hyperlipidemia by applying a theoretical framework. Data from the 2018 Medical Expenditure Panel Survey were used to identify the population of non-institutionalized U.S. civilians diagnosed with hyperlipidemia. This cross sectional study applied the Andersen Behavioral Model to identify patients’ predisposing, enabling, and need factors. Approximately 43 million non-institutionalized adults were diagnosed with hyperlipidemia. With the exception of gender and race, predisposing factors indicated significant differences between patients who used antihyperlipidemic agents and those who did not. The relation between income level and use of antihyperlipidemic agents was significant: X2 (4, N = 3,781) = 7.09, p <.001. Hispanic patients were found to be less likely to receive treatment (OR: 0.62; 95% CI: 0.43–0.88), as observed using a logistic model, with controls for predisposing, enabling, and need factors. Patients without health insurance were less likely to use lipid-lowering agents (OR: 0.33; 95% CI: 0.14–0.77). The present study offers essential data for prioritizing interventions by health policy makers by identifying barriers in utilizing hyperlipidemia therapy. Non-adherence to treatment may lead to severe consequences and increase the frequency of fatal cardiac events in the near future.

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The Ecology of Antihypertensives in the United States, 1997-2017

10.1101/2020.04.01.20050146 ◽

2020 ◽

Author(s):

Michael E. Johansen ◽

Joshua D. Niforatos ◽

Jeremey B. Sussman

Keyword(s):

United States ◽

Beta Blocker ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Medical Expenditure ◽

Future Research ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Cross Sectional ◽

Medication Class

AbstractBackgroundAntihypertensives are the most used medication type in the United States, yet there remains uncertainty about the use of different antihypertensives. We sought to characterize use of antihypertensives by and within medication class(es) between 1997-2017.MethodsA repeated cross-sectional study of 493,596 adult individuals using the 1997-2017 Medical Expenditure Panel Survey (MEPS). The Orange Book and published research were used for adjunctive information. The primary outcome was the estimated use by and within anti-hypertensive medication class(es).ResultsThe proportion of individuals taking any antihypertensive during a year increased from 1997 to the early 2010’s and then remained stable. The proportion of the population taking 2 or more medications declined from 2015-2017. The proportion of adults using angiotensin II receptor-blockers (ARBs) and dihydropyridine calcium channel-blockers (CCBs) increased during the study period, while angiotensin-converting enzyme inhibitors (ACE-Is) increased until 2010 after which rates remained stable. Beta-blocker use was similar to ACE-Is with an earlier decline starting in 2012. Thiazide diuretic use increased from 1997-2007, leveled off until 2014, and declined from 2015-2017. Non-dihydropyridine CCBs use declined throughout the study. ACE-Is, ARBs, CCBs, thiazide diuretics, and loop diuretics all had one dominant in-class medication. There was a clear increase in the use of losartan within ARBs, lisinopril within ACE-Is, and amlodipine within CCBs following generic conversion. Furosemide and hydrochlorothiazide started with and maintained a dominant position in their classes. Metoprolol use increased throughout the study and became the dominant beta-blocker, while atenolol peaked around 2005 and then declined thereafter.ConclusionsAntihypertensive classes appear to have a propensity to equilibrate to an individual medication, despite a lack of outcomes based research to compare medications within a class. Future research could focus on comparative effectiveness for within-class medications early in the life cycle of therapeutics that are probable to have wide spread use.

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Depression treatment in individuals with cancer: a comparative analysis with cardio-metabolic conditions

Health Psychology Research ◽

10.4081/hpr.2013.632 ◽

2013 ◽

Vol 1 (1) ◽

pp. 2 ◽

Cited By ~ 2

Author(s):

Pallavi B. Rane ◽

Usha Sambamoorthi ◽

Suresh Madhavan

Keyword(s):

Medical Expenditure Panel Survey ◽

Household Survey ◽

The United States ◽

Primary Objective ◽

Medical Expenditure ◽

Depression Treatment ◽

Cross Sectional ◽

Physician Visits ◽

Lifestyle Risk Factors ◽

Metabolic Conditions

A clear picture of the current state of nationwide depression treatment practices in individuals with cancer and depression does not exist in the United States (US). Therefore, the primary objective of this study was to examine rates of any depression treatment among individuals with cancer and depression in the US. To better understand the relationship between any treatment for depression and presence of cancer, we used a comparison group of individuals with cardio-metabolic conditions owing to the similar challenges faced in management of depression in individuals with these conditions. We used a retrospective cross-sectional design and data from multiple years of the Medical Expenditure Panel Survey, a nationally representative household-survey on healthcare utilization and expenditures. Study sample consisted of adults aged 21 or older with self-reported depression and cancer (n=528) or self-reported depression and diabetes, heart disease or hypertension (n=1643). Depression treatment comprised of any use of antidepres- sants and/or any use of mental health counseling services. Treatment rates for depression were 78.0% and 81.7% among individuals with cancer and cardio-metabolic conditions respectively. After controlling for socio-demographic, access-to-care, number of physician-visits, health-status, and lifestyle risk-factors related variables; individuals with cancer were less likely to report any treatment for depression (Adjusted Odds Ratio=0.67; 95% Confidence Interval=0.49, 0.92) compared to individuals with cardio-metabolic conditions (P≤0.01). Our findings highlight the possibility that competing demands may crowd out treatment for depression and that cancer diagnosis may be a barrier to depression treatment.

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Association of Self-Reported Frequent Exercise Among a Nationally Representative Sample of Older People in the United States With Self-Reported Pain

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0268 ◽

2020 ◽

pp. 1-8

Author(s):

David R. Axon ◽

Niloufar Emami

Keyword(s):

Physical Health ◽

Chronic Conditions ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Medical Expenditure ◽

Cross Sectional ◽

Logistic Regression Models ◽

Poor Physical Health ◽

Nationally Representative ◽

Fair Poor

This retrospective, cross-sectional database study aimed to identify characteristics associated with self-reported frequent exercise (defined as moderate- to vigorous-intensity exercise for ≥30 min five times a week) in older U.S. (≥50 years) adults with pain in the past 4 weeks, using 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models. The variables significantly associated with frequent exercise included being male (adjusted odds ratio [AOR] = 1.507, 95% confidence interval [CI] [1.318, 1.724]); non-Hispanic (AOR = 1.282, 95% CI [1.021, 1.608]); employed (AOR = 1.274, 95% CI [1.040, 1.560]); having no chronic conditions versus ≥5 conditions (AOR = 1.576, 95% CI [1.094, 2.268]); having two chronic conditions versus ≥5 conditions (AOR = 1.547, 95% CI [1.226, 1.952]); having no limitation versus having a limitation (AOR = 1.209, 95% CI [1.015, 1.441]); having little/moderate versus quite/extreme pain (AOR = 1.358, 95% CI [1.137, 1.621]); having excellent/very good versus fair/poor physical health (AOR = 2.408, 95% CI [1.875, 3.093]); and having good versus fair/poor physical health (AOR = 1.337, 95% CI [1.087, 1.646]). These characteristics may be useful to create personalized pain management protocols that include exercise for older adults with pain.

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PATTERNS OF PSYCHOACTIVE MEDICATION USE IN COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES IN 2015

Innovation in Aging ◽

10.1093/geroni/igz038.2608 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S710-S710

Author(s):

Rashmita Bajracharya ◽

Danya Qato

Keyword(s):

Older Adults ◽

Low Income ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Community Dwelling ◽

Medical Expenditure ◽

Cross Sectional ◽

Psychoactive Medication ◽

Community Dwelling Older Adults ◽

Psychoactive Medications

Abstract Per the 2015 Beer’s Criteria, most psychoactive medications are identified as potentially inappropriate for use in older adults as this population is especially vulnerable to the potential adverse effects associated with psychoactive medications, including sedation, anticholinergic effects, and falls. Past studies found increasing use of psychoactive medications in community-dwelling older adults; however, patterns of use by other sociodemographic, socioeconomic, and clinical subgroups have not been explored. This is a cross-sectional analysis of 2015 Medical Expenditure Panel Survey in a sample of 6122 older adults (60-85 years). We utilized Andersen’s Behavioral Model of Health Services Utilization to guide logistic regression model development and estimated odds ratios (OR) with 95% confidence intervals (CI) to quantify the association between psychoactive use and predisposing(sex and race); enabling(marital status, education, poverty, insurance); and need-based[multi-morbidity and activities of daily living (ADL) limitations] factors. Over 30% of older adults in the U.S. reported taking a psychoactive medication in 2015. Prevalence of use was significantly higher in women (35.9%), the unmarried(34.1%), low-income(35.7%), white(34.0%), multimorbid (32.0%), and ADL limitation groups (45.9%) compared to men, married, high-income, other races, not multimorbid, and no ADL limitations groups, respectively. Female sex [OR=1.62(1.38-1.91)], low-income [OR=1.30(1.04-1.6)], multimorbidity [OR=3.2(2.6-3.9)], and ADL limitations [OR=2.2(1.7-2.8)] were identified as independent predictors of psychoactive use. There is differential use of psychoactive medications by sociodemographic, socioeconomic, and clinical factors. Given the increased complexity of pharmacotherapy regimens, especially in those with multimorbidity and ADL limitations, improved efforts aimed at prudent use of psychoactive medications should be intensified.

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Trends in Mail-Order Prescription Use among U.S. Adults from 1996 to 2018: A Nationally Representative Repeated Cross-Sectional Study

10.1101/2020.09.22.20199505 ◽

2020 ◽

Author(s):

Duy Do ◽

Pascal Geldsetzer

Keyword(s):

Medical Expenditure Panel Survey ◽

The United States ◽

Medical Expenditure ◽

Annual Number ◽

Considerable Proportion ◽

Mail Order ◽

Cross Sectional ◽

Population Groups ◽

Nationally Representative ◽

The U.S

Background. Mail-order prescriptions are popular in the U.S., but the recent mail delays due to operational changes at the United States Postal Services (USPS) may postpone the delivery of vital medications. Despite growing recognition of the health and economic effects of a postal crisis on mail-order pharmacy consumers, little is known about the extent of mail-order prescription use, and most importantly, the population groups and types of medications that will likely be most affected by these postal delays. Methods. The prevalence of mail-order prescription use was assessed using a nationally representative repeated cross-sectional survey (the Medical Expenditure Panel Survey) carried out among adults aged 18 and older in each year from 1996 to 2018. We stratified use of mail-order prescription by socio-demographic and health characteristics. Additionally, we calculated which prescription medications were most prevalent among all mailed medications, and for which medications users were most likely to opt for mail-order prescription. Findings. 500,217 adults participated in the survey. Between 1996 and 2018, the prevalence of using at least one mail-order prescription in a year among U.S. adults was 9.8% (95% CI, 9.5%-10.0%). Each user purchased a mean of 19.4 (95% CI, 19.0-19.8) mail-order prescriptions annually. The prevalence of use increased from 6.9% (95% CI, 6.4%-7.5%) in 1996 to 10.3% (95% CI, 9.7%-10.9%) in 2018, and the mean annual number of mail-order prescriptions per user increased from 10.7 (95% CI, 9.8-11.7) to 20.5 (95% CI, 19.3-21.7) over the same period. Use of mail-order prescription in 2018 was common among adults aged 65 and older (23.9% [95% CI, 22.3%-25.4%]), non-Hispanic whites (13.6% [95% CI, 12.8%-14.5%]), married adults (12.7% [95% CI, 11.8%-13.6%]), college graduates (12.2% [95% CI, 11.3%-13.1%]), high-income adults (12.6%, [95% CI, 11.6%-13.6%]), disabled adults (19.3% [95% CI, 17.9%-20.7%]), adults with poor health status (15.6% [95% CI, 11.6%-19.6%]), adults with three or more chronic conditions (24.2% [95% CI, 22.2%-26.2%]), Medicare beneficiaries (22.8% [95% CI, 21.4%-24.3%]), and military-insured adults (13.9% [95% CI, 10.8%-17.1%]). Mail-order prescriptions were commonly filled for analgesics, levothyroxine, cardiovascular agents, antibiotics, and diabetes medications. Interpretation. The use of mail-order prescription, including for critical medications such as insulin, is increasingly common among U.S. adults and displays substantial variation between population groups. A national slowdown of mail delivery could have important health consequences for a considerable proportion of the U.S. population, particularly during the current Coronavirus disease 2019 epidemic.

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The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1204 ◽

2010 ◽

Vol 13 (2) ◽

Cited By ~ 6

Author(s):

John F Cogan ◽

R. Glenn Hubbard ◽

Daniel Kessler

Keyword(s):

United States ◽

Health Reform ◽

Medical Expenditure Panel Survey ◽

Private Insurance ◽

The United States ◽

Medical Expenditure ◽

Insurance Premiums ◽

Reform Plan ◽

The Difference ◽

The Cost

In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008that is, before versus after the planover and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does suggest that policy makers should be concerned about the consequences of health reform for the cost of private insurance.

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Are There Racial Disparities in Psychotropic Drug Use and Expenditures in a Nationally Representative Sample of Men in the United States? Evidence From the Medical Expenditure Panel Survey

American Journal of Men s Health ◽

10.1177/1557988313496564 ◽

2013 ◽

Vol 8 (1) ◽

pp. 82-90 ◽

Cited By ~ 6

Author(s):

Geraldine Pierre ◽

Roland J. Thorpe ◽

Gniesha Y. Dinwiddie ◽

Darrell J. Gaskin

Keyword(s):

United States ◽

Drug Use ◽

Racial Disparities ◽

Psychotropic Drug ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Medical Expenditure ◽

Panel Survey ◽

Psychotropic Drug Use ◽

Nationally Representative

This article sought to determine whether racial disparities exist in psychotropic drug use and expenditures in a nationally representative sample of men in the United States. Data were extracted from the 2000-2009 Medical Expenditure Panel Survey, a longitudinal survey that covers the U.S. civilian noninstitutionalized population. Full-Year Consolidated, Medical Conditions, and Prescribed Medicines data files were merged across 10 years of data. The sample of interest was limited to adult males aged 18 to 64 years, who reported their race as White, Black, Hispanic, or Asian. This study employed a pooled cross-sectional design and a two-part probit generalized linear model for analyses. Minority men reported a lower probability of psychotropic drug use (Black = −4.3%, 95% confidence interval [CI] = [−5.5, −3.0]; Hispanic = −3.8%, 95% CI = [−5.1, −2.6]; Asian = −4.5%, 95% CI = [−6.2, −2.7]) compared with White men. After controlling for demographic, socioeconomic, and health status variables, there were no statistically significant race differences in drug expenditures. Consistent with previous literature, racial and ethnic disparities in the use of psychotropic drugs present problems of access to mental health care and services.

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Union, Premium Cost, and the Provision of Employment-based Health Insurance

Socius Sociological Research for a Dynamic World ◽

10.1177/2378023118798502 ◽

2018 ◽

Vol 4 ◽

pp. 237802311879850

Author(s):

Ken-Hou Lin ◽

Samuel Bondurant ◽

Andrew Messamore

Keyword(s):

Medical Expenditure Panel Survey ◽

Health Benefits ◽

State Level ◽

The United States ◽

Critical Force ◽

First Century ◽

Medical Expenditure ◽

Health Plans ◽

Panel Survey ◽

Employment Relationships

The decline of employment-based health plans is commonly attributed to rising premium costs. Using restricted data and a matched sample from the Medical Expenditure Panel Survey–Insurance Component, the authors extend previous studies by testing the relationships among premium costs, employment relationships, and the provision of health benefits between 1999 and 2012. The authors report that both establishment- and state-level union densities are associated with a higher likelihood of employers’ providing health plans, whereas right-to-work legislation is associated with lower provision. These factors combined rival rising premium cost in predicting offering. This finding indicates that the declining provision of health benefits could be in part driven by the transformation of the employment relationship in the United States and that labor unions may remain a critical force in sustaining employment-based coverage in the twenty-first century.

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ASSOCIATION OF SERUM MAGNESIUM LEVEL WITH RESISTANT HYPERLIPIDEMIA IN DIABETIC AND HYPERTENSIVE PATIENTS

10.36106/7335960 ◽

2021 ◽

pp. 33-35

Author(s):

Manish Kumar ◽

Syed Yousuf Faisal ◽

Sudhir Chandra Jha ◽

Debarshi Jana

Keyword(s):

Serum Magnesium ◽

Cross Sectional Study ◽

Magnesium Level ◽

Lipid Lowering ◽

Diabetic Patients ◽

Serum Magnesium Level ◽

Cross Sectional ◽

Hypertensive Patients ◽

Present Cross Sectional Study ◽

Lipid Lowering Agents

Introduction: Both diabetes mellitus and hypertension are aspects of metabolic syndrome. Objectives: The aim of this study was to determine the relationship between serum magnesium level with resistant hyperlipidemia in a group of diabetic and hypertensive patients. Patients And Methods: The present cross- sectional study was carried out on 90 hypertensive and diabetic patients in Medicine Department of DMCH, Laheriasarai, Bihar, (45 hypertensive and 45 diabetic patients). Included patients had high triglyceride levels despite 8 weeks of treatment with lipid-lowering agents. Results: There was an inverse signicant relationship between serum magnesium and triglyceride levels in diabetic patients (P=0.002, r=-0.458), however, this correlation was not signicant in hypertensive patients (P=0.754, r=0.048). Conclusion: This study showed, serum magnesium may affect triglycerides levels in diabetic patients, however, our nding requires further investigation with larger population

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Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0301 ◽

2021 ◽

pp. 1-9

Author(s):

David R. Axon ◽

Jonathan Chien ◽

Hanh Dinh

Keyword(s):

Health Care ◽

Medical Expenditure Panel Survey ◽

Survey Design ◽

Health Care Expenditure ◽

Prescription Medication ◽

Health Care Expenditures ◽

Cross Sectional Study ◽

Medical Expenditure ◽

Cross Sectional ◽

Nationally Representative

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate–vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

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