Is Shelter-in-Place Policy Related to Mail Order Pharmacy Use and Racial/Ethnic Disparities for Patients With Diabetes?

Type 2 diabetes plays a major role in racial/ethnic health disparities. We conducted the first study to examine whether multifaceted interventions targeting patients with poorly controlled diabetes (HgbA1c >9%) can reduce racial/ethnic disparities in diabetes control. Among 4595 patients with diabetes at a Federally Qualified Health Center in New York, a higher percentage of blacks (32%) and Hispanics/Latinos (32%) had poorly controlled diabetes than whites (25%) at baseline (prevalence ratio, 1.28; 95% CI, 1.14–1.43; P<0.001). After four years, this percentage was reduced in all groups (blacks, 21%; Hispanics/Latinos, 20%; whites, 20%; P<0.001 for each relative to baseline). Disparities in diabetes control also were significantly reduced (change in disparity relative to whites: blacks, P=0.03; Hispanics/Latinos, P=0.008). In this diverse population, interventions targeting patients with poorly controlled diabetes not only improved diabetes control in all racial/ethnic groups, but significantly reduced disparities. This approach warrants further testing and may help reduce disparities in other populations.

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Study finds racial/ethnic disparities in depressive trajectories among middle-aged or older adults

PsycEXTRA Dataset ◽

10.1037/e531082012-003 ◽

2012 ◽

Author(s):

J. Liang ◽

X. Xu ◽

A. R. Quinones ◽

J. M. Bennett ◽

W. Ye

Keyword(s):

Older Adults ◽

Ethnic Disparities ◽

Middle Aged ◽

Racial Ethnic

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Opportunities to Encourage Mail Order Pharmacy Use in Diabetes—A Qualitative Study

Diabetes ◽

10.2337/db18-2322-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2322-PUB ◽

Cited By ~ 1

Author(s):

JULIE SCHMITTDIEL ◽

CASSONDRA MARSHALL ◽

DEANNE WILEY ◽

CHRISTOPHER V. CHAU ◽

CONNIE M. TRINACTY ◽

...

Keyword(s):

Qualitative Study ◽

Mail Order ◽

Mail Order Pharmacy

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1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States

Diabetes ◽

10.2337/db20-1489-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1489-P

Author(s):

SHARON SHAYDAH ◽

GIUSEPPINA IMPERATORE ◽

CARLA MERCADO ◽

KAI M. BULLARD ◽

STEPHEN R. BENOIT

Keyword(s):

United States ◽

Ethnic Disparities ◽

Diabetic Coma ◽

Racial Ethnic

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Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.2807 ◽

2017 ◽

Vol 35 (1) ◽

pp. 86-95 ◽

Cited By ~ 35

Author(s):

Albert J. Farias ◽

Xianglin L. Du

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Ethnic Disparities ◽

Medication Possession Ratio ◽

Adjuvant Endocrine Therapy ◽

Hormone Receptor Positive ◽

Medication Costs ◽

Poverty Status ◽

Racial Ethnic ◽

Out Of Pocket Costs

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

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Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?

International Journal of Health Geographics ◽

10.1186/1476-072x-10-24 ◽

2011 ◽

Vol 10 (1) ◽

pp. 24 ◽

Cited By ~ 21

Author(s):

Nancy Tian ◽

J Gaines Wilson ◽

F Benjamin Zhan

Keyword(s):

Breast Cancer ◽

Late Stage ◽

Spatial Association ◽

Ethnic Disparities ◽

Female Breast Cancer ◽

Female Breast ◽

Late Stage Diagnosis ◽

Racial Ethnic

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Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

Innovation in Aging ◽

10.1093/geroni/igaa057.545 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Chirag Vyas ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Olivia Okereke

Keyword(s):

Native American ◽

Ethnic Differences ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Omega 3 ◽

Late Life Depression ◽

Item Level ◽

Racial Ethnic ◽

Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

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