TY - JOUR
T1 - Primary language, income and the intensification of anti-glycemic medications in managed care
T2 - The (TRIAD) study
AU - Duru, O. Kenrik
AU - Bilik, Dori
AU - McEwen, Laura N.
AU - Brown, Arleen F.
AU - Karter, Andrew J.
AU - Curb, J. David
AU - Marrero, David G.
AU - Lu, Shou En
AU - Rodriguez, Michael
AU - Mangione, Carol M.
N1 - Funding Information:
ACKNOWLEDGEMENTS: This study was jointly funded by Program Announcement number 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding organizations. Significant contributions to this study were made by members of the Translating Research into Action for Diabetes (TRIAD) Study Group. The authors in particular acknowledge Robert Gerzoff, MS for his extensive statistical and programming assistance. The authors also acknowledge the participation of our health plan partners. Dr. Duru and Dr. Rodriguez received support from the Network for Multicultural Research on Health and Healthcare, funded by the Robert Wood Johnson Foundation. Dr. Mangione received support from the Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) funded by the NIH/NIA (P30 AG021684), and the UCLA Older Americans Independence Center funded by the NIH/NIA (5 P30 AG028748). Dr. Mangione and Dr. Rodriguez received support from the Drew/ UCLA Project EXPORT Center funded by the NIH/NCMHHD (P20 MD000182).
PY - 2011/5
Y1 - 2011/5
N2 - BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.
AB - BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.
UR - https://www.scopus.com/pages/publications/79958751942
UR - https://www.scopus.com/pages/publications/79958751942#tab=citedBy
U2 - 10.1007/s11606-010-1588-2
DO - 10.1007/s11606-010-1588-2
M3 - Article
C2 - 21174165
AN - SCOPUS:79958751942
SN - 0884-8734
VL - 26
SP - 505
EP - 511
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 5
ER -