Gender Disparities in Health Resource Utilization in Patients with Atherosclerotic Cardiovascular Disease: A Retrospective Cross-Sectional Study

Abstract

IntroductionGender disparities in access to healthcare have been documented, including disparities in access to care for cardiovascular diseases (CVDs). Disparities in access to cardiologists could disadvantage some patients to the newer lipid-lowering proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) antibodies, as utilization management criteria for PCSK9is often require step therapy with statins and/or ezetimibe and prescription by a cardiologist. To assess whether these utilization management criteria disproportionally limit access to patients with certain characteristics, we assessed the use of cardiologist care and receipt of statin and/or ezetimibe prescriptions from a cardiologist by gender and other patient demographic and clinical characteristics.MethodsThis cross-sectional study used administrative claims data from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®) for patients enrolled in commercial and Medicare Advantage healthcare plans from January 1, 2014, through December 31, 2014. Provider data from the registry were linked to individual demographic and administrative claims data. Logistic regression models were used to assess characteristics associated with outpatient visits to a cardiologist and receipt of a prescription for statin and/or ezetimibe from a cardiologist.ResultsData from 39,322 patients in commercial plans and 261,898 patients with Medicare Advantage were analyzed. Female gender (vs male) was associated with a significantly lower likelihood of visiting a cardiologist for patients in commercial plans (odds ratio [OR] 0.85; 95% confidence limit [CL] 0.81–0.88) and in Medicare Advantage plans (OR 0.82; 95% CL 0.81–0.83). Female gender was also associated with a lower likelihood of receiving a statin and/or ezetimibe prescription from a cardiologist for patients in commercial plans (OR 0.69; 95% CL 0.65–0.74) and in Medicare Advantage plans (OR 0.78; 95% CL 0.76–0.79).ConclusionsCompared with men, women were less likely to visit a cardiologist and less likely to receive a prescription for a statin and/or ezetimibe from a cardiologist.FundingAmgen Inc.

Update on Management of Cardiovascular Diseases in Women

“…In the PHARMO database, the proportion of women using lipid-lowering drugs in primary prevention was lower than men [ 212 ]. A lower prescription of statin and ezetimibe in women has been also shown [ 213 ].…”

Evaluation and management of blood lipids through a woman's life cycle

“…Black and Asian women were least likely to achieve LDL goals [75] . When compared to men, women with established CVD are less likely to receive a statin or ezetimibe [76] . PCSK9 inhibitor prescription rejections are higher in women, racial minorities and lower income groups.…”

Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis

“…Cardiovascular disease (CVD) is the leading cause of death in the U.S., and cardiometabolic risk factors for CVD are prevalent and well-known [ 1 , 2 ]. Despite the availability of effective treatments, significant disparities in CVD and cardiometabolic outcomes persist [ 3 , 4 , 5 , 6 ]. Care coordination can reduce fragmentation in care, and team-based care with community-based support can help address behavioral and social determinants of cardiometabolic risks [ 7 , 8 , 9 , 10 , 11 , 12 ].…”