Gaps in Dyslipidemia Care Among Working‐Aged Individuals With Employer‐Sponsored Health Care

Abstract

Background The American Heart Association and American College of Cardiology guidelines defined patient‐management groups that would benefit from lowering of low‐density lipoprotein cholesterol (LDL‐C). We assessed gaps in dyslipidemia care among employees and spouses with health benefits. Methods and Results We studied 17 889 employees and spouses who were covered by an employer‐sponsored health plan and participated in an annual health assessment. Using medical claims, laboratory tests, and risk assessment questionnaires, we found that 43% of participants were in one of 4 patient‐management groups: secondary prevention, severe hypercholesterolemia ( LDL ‐C ≥190 mg/dL at least once in the preceding 5 years), diabetes mellitus, or elevated 10‐year risk of cardiovascular disease. To assess gaps in dyslipidemia care, we used LDL ‐C ≤70 mg/dL as the goal for both the secondary prevention group and those in the elevated 10‐year risk group with >20% risk; LDL‐C ≤100 mg/dL was used for the other groups. Among those in patient‐management groups, 27.3% were in the secondary prevention group, 7.4% were in the severe hypercholesterolemia group, 29.9% were in the diabetes mellitus group, and 35.4% were in the elevated 10‐year risk group. About 74% of those in patient‐management groups had above‐goal LDL ‐C levels, whereas only 31% had evidence of a lipid‐lowering therapy in the past 6 months: 45% in the secondary prevention group, 31% in the severe hypercholesterolemia group, 36% in the diabetes mellitus group, and 17% in the elevated 10‐year risk group. Conclusions The substantial gaps in LDL ‐C treatment and goal attainment among members of an employer‐sponsored medical plan who were mostly aware of their LDL ‐C levels indicate the need for gap‐closure initiatives.

Social Determinants of Health Challenges Are Prevalent Among Commercially Insured Populations

“…Recent studies of individuals with employer-sponsored insurance have described utilization patterns for preventive services, 7 delays in care, 8 as well as hospital admissions and emergency department visits, 9 but few have considered this information in light of social determinants of health, such as worker wage level 1 or place of residence. 10 To date, none have explored the prevalence of social determinants of health with associated clinical risk factors for common medical conditions within a large commercially insured population.…”