Disparities in lipid management for African Americans and Caucasians with coronary artery disease: A national cross-sectional study Public Deposited

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Creator
  • Alexander, Charles M
    • Other Affiliation: Outcomes Research and Management, Merck & Company, West Point, Pennsylvania, USA
  • Foley, Kathleen A
    • Other Affiliation: Outcomes Research and Management, Merck & Company, West Point, Pennsylvania, USA
  • Sueta, Carla A.
    • Affiliation: School of Medicine, Division of Cardiology, Department of Medicine
  • Massing, Mark W
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
    • Other Affiliation: Health Care Assessment, Medical Review of North Carolina, Cary, North Carolina, USA
  • Simpson, Ross, Jr.
    • Affiliation: School of Medicine, Division of Cardiology, Department of Medicine
  • Carter-Edwards, Lori
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
    • Other Affiliation: Institute for Health, Social, and Community Research, Shaw University, Raleigh, North Carolina, USA
Abstract
  • Abstract Background Individuals with coronary artery disease are at high risk for adverse health outcomes. This risk can be diminished by aggressive lipid management, but adherence to lipid management guidelines is far from ideal and substantial racial disparities in care have been reported. Lipid treatment and goal attainment information is not readily available for large patient populations seen in the fee-for-service setting. As a result, national programs to improve lipid management in this setting may focus on lipid testing as an indicator of lipid management. We describe the detection, treatment, and control of dyslipdemia for African Americans and Caucasians with coronary artery disease to evaluate whether public health programs focusing on lipid testing can eliminate racial disparities in lipid management. Methods Physicians and medical practices with high numbers of prescriptions for coronary artery disease medications were invited to participate in the Quality Assurance Program. Medical records were reviewed from a random sample of patients with coronary artery disease seen from 1995 through 1998. Data related to the detection, treatment, and control of dyslipidemia were abstracted from the medical record and evaluated in cross-sectional stratified and logistic regression analyses using generalized estimation equations. Results Data from the medical records of 1,046 African Americans and 22,077 Caucasians seen in outpatient medical practices in 23 states were analyzed. African-American patients were younger, more likely to be women and to have diabetes, heart failure, and hypertension. The low density lipoprotein cholesterol (LDL-C) testing rate for Caucasian men was over 1.4 times higher than that for African-American women and about 1.3 times higher than that for African-American men. Almost 60% of tested Caucasian men and less than half of tested African Americans were prescribed lipid-lowering drugs. Tested and treated Caucasian men had the highest LDL-C goal attainment (35%) and African-American men the lowest (21%). Conclusions Although increased lipid testing is clearly needed for African Americans, improvements in treatment and control are also necessary to eliminate racial disparities in lipid management. Disparities in treatment and goal attainment must be better understood and reflected in policy to improve the health of underserved populations.
Date of publication
Identifier
  • doi:10.1186/1471-2261-4-15
  • 15317654
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Mark W Massing et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Cardiovascular Disorders
Journal volume
  • 4
Journal issue
  • 1
Page start
  • 15
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2261
Bibliographic citation
  • BMC Cardiovascular Disorders. 2004 Aug 18;4(1):15
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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