Social and Political Correlates of Geographic Disparities in HIV and Cardiovascular Medication Utilization

OBJECTIVES: Increased prevalence of cardiovascular disease and human immunodeficiency virus (HIV) in Black communities leads to excessive mortality. Equitable access and adherence to medicines to prevent and manage disease progression can play important roles in reducing such disparities in health outcomes. The objective was to identify social and political correlates of state-level disparities in medication utilization for older adults diagnosed with cardiovascular disease and HIV.

METHODS: Cardiovascular disease, HIV prevalence, and medication utilization (i.e., persistence and adherence based on seven National Quality Forum and Pharmacy Quality Alliance measures), were estimated using claims data for the 2020 Medicare fee-for-service population. Results were uploaded to the Morehouse School of Medicine Satcher Health Leadership Institute Health Equity Tracker (HET). The HET includes social determinants of health, political determinants of health, and other epidemiological data from various public sources. Using the HET’s heat map feature, correlations between social and political determinants of health and rates of medication utilization across U.S. states and counties were identified.

RESULTS: There are a range of disparities in medication utilization across the U.S. For example, in certain states and districts where greater than 15% of the population fell below the Federal Poverty Level, including the District of Columbia, Mississippi, and West Virginia, we found disparities of 14% or more between the share of Black and White adults persistent to beta blockers after a heart attack. In certain states with lower voter participation (below 65%), such as Alabama, Arkansas, and Nevada, the difference between the percentage of Black and White adults adherent to antiretroviral medicines exceeded 15%.

CONCLUSIONS: Results demonstrate that racialized, economic, sociopolitical, and other social factors are associated with the geospatial disparities in medication utilization. More research is needed to understand these associations. Public health tools, such as the HET, provide decision makers with evidence of health inequalities needing to be addressed.