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Frequency of Disparities in Laboratory Testing After Statin Initiation in Subjects ≥65 Years

      Laboratory testing is important for the safety of older adults initiating statins, but there has been little examination of laboratory testing disparities by race/ethnicity, age, gender, Medicaid eligibility, and multimorbidity. The study's purpose was to examine disparities in guideline-concordant baseline laboratory testing and abnormal laboratory values among a retrospective cohort of 76,868 Medicare fee-for-service beneficiaries from 10 states in the eastern United States who had dyslipidemia and initiated a statin from July 1 to November 30, 2011. Guideline-concordant assessment of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was defined as evidence of an outpatient claim for either test within 180 days before or 14 days after the date of the index statin fill. In 2011, baseline laboratory testing rates were 89.3% for ALT and 88.8% for AST. Older adults were somewhat more likely to have ALT and AST testing if they were dually enrolled in Medicaid (relative risk 1.01, 95% confidence interval [CI] 1.00 to 1.02) or had multiple chronic conditions (relative risk 1.03, 95% CI 1.00 to 1.06 for 2 to 3 conditions; odds ratio [OR] 1.08, 95% CI 1.05 to 1.11 for 4 to 5 conditions; OR 1.14, 95% CI 1.11 to 1.17 for 6+ conditions), compared with 0 to 1 conditions. Non-Hispanic blacks were less likely to receive baseline testing (OR 0.97, 95% CI 0.96 to 0.98) than non-Hispanic Whites, and male beneficiaries were somewhat less likely to receive testing than female beneficiaries (OR 0.99, 95% CI 0.98 to 0.99). Abnormal values were rare. In conclusion, ALT and AST assessment after statin initiation was commonly done as recommended, and there were negligible disparities in testing rates for beneficiaries.
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      References

        • Hammill B.G.
        • Curtis L.H.
        • Qualls L.G.
        • Hastings S.N.
        • Wang V.
        • Maciejewski M.L.
        Linkage of laboratory results to Medicare fee-for-service claims.
        Med Care. 2015; 53: 974-979
        • Raebel M.A.
        • Lyons E.E.
        • Andrade S.E.
        • Chan K.A.
        • Chester E.A.
        • Davis R.L.
        • Ellis J.L.
        • Feldstein A.
        • Gunter M.J.
        • Lafata J.E.
        • Long C.L.
        • Magid D.J.
        • Selby J.V.
        • Simon S.R.
        • Platt R.
        Laboratory monitoring of drugs at initiation of therapy in ambulatory care.
        J Gen Intern Med. 2005; 20: 1120-1126
        • Simon S.R.
        • Andrade S.E.
        • Ellis J.L.
        • Nelson W.W.
        • Gurwitz J.H.
        • Lafata J.E.
        • Davis R.L.
        • Feldstein A.
        • Raebel M.A.
        Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees.
        J Am Geriatr Soc. 2005; 53: 2165-2169
        • Eicheldinger C.
        • Bonito A.
        More accurate racial and ethnic codes for Medicare administrative data.
        Health Care Financ Rev. 2008; 29: 27-42
      1. Chronic Conditions Among Medicare Beneficiaries, Chartbook. Centers for Medicare and Medicaid Services, Baltimore, Maryland2012: 1-30
        • Qato D.M.
        • Alexander G.C.
        • Conti R.M.
        • Johnson M.
        • Schumm P.
        • Lindau S.T.
        Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States.
        JAMA. 2008; 300: 2867-2878
        • Gouni-Berthold I.
        • Berthold H.K.
        • Mantzoros C.S.
        • Bohm M.
        • Krone W.
        Sex disparities in the treatment and control of cardiovascular risk factors in type 2 diabetes.
        Diabetes Care. 2008; 31: 1389-1391
        • Gurwitz J.H.
        • Field T.S.
        • Harrold L.R.
        • Rothschild J.
        • Debellis K.
        • Seger A.C.
        • Cadoret C.
        • Fish L.S.
        • Garber L.
        • Kelleher M.
        • Bates D.W.
        Incidence and preventability of adverse drug events among older persons in the ambulatory setting.
        JAMA. 2003; 289: 1107-1116
      2. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report.
        Circulation. 2002; 106: 3143-3421
        • Pasternak R.C.
        • Smith Jr., S.C.
        • Bairey-Merz C.N.
        • Grundy S.M.
        • Cleeman J.I.
        • Lenfant C.
        ACC/AHA/NHLBI clinical advisory on the use and safety of statins.
        Circulation. 2002; 106: 1024-1028
        • Fox M.H.
        • Reichard A.
        Disability, health, and multiple chronic conditions among people eligible for both Medicare and Medicaid, 2005-2010.
        Prev Chronic Dis. 2013; 10: E157
        • Schiff G.D.
        • Klass D.
        • Peterson J.
        • Shah G.
        • Bates D.W.
        Linking laboratory and pharmacy: opportunities for reducing errors and improving care.
        Arch Intern Med. 2003; 163: 893-900
        • Steinman M.A.
        • Handler S.M.
        • Gurwitz J.H.
        • Schiff G.D.
        • Covinsky K.E.
        Beyond the prescription: medication monitoring and adverse drug events in older adults.
        J Am Geriatr Soc. 2011; 59: 1513-1520