RACIAL, ETHNIC, AND SOCIOECONOMIC DISPARITIES IN P2Y12 INHIBITOR PRESCRIBING FOLLOWING PCI IN MEDICARE BENEFICIARIES
Author(s)
Kamika Reynolds, PhD, Kimberly O’Malley, MS, Chintan Dave, PharmD, PhD;
Rutgers University, New Brunswick, NJ, USA
Rutgers University, New Brunswick, NJ, USA
OBJECTIVES: Dual antiplatelet therapy is the standard treatment for patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). There is limited data exploring P2Y12 inhibitor prescribing trends by racial, ethnic, and social determinants of health (SDH).
METHODS: This was a retrospective cohort study that used Medicare data from 2010 to 2021 to identify patients who underwent PCI for ACS. The rates of initiation and therapeutic escalation and deescalation of each P2Y12 inhibitor was assessed across racial and ethnic subgroups. The Social Vulnerability Index (SVI) was used to assess socioeconomic status of different ethnic groups. Baseline bleeding risk was evaluated using the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.
RESULTS: 297,599 participants met the eligibility criteria. The mean (SD) age of patients was 76.0 (6.9) years; 44.2% of patients were female. After adjusting for patient characteristics, both Black and Hispanic patients had lower odds of prasugrel or ticagrelor initiation compared to White patients; Black and Hispanic patients were 12% (OR 0.88 [95% CI, 0.85-0.92]) and 3% (OR 0.97 [95% CI, 0.94-1.01]) less likely to be initiated on ticagrelor or prasugrel, respectively. Overall 12-month escalation rates were 3% (n=4,832) and deescalation rates were 33.5% (n=23,003). Black patients were 17% less likely to undergo therapeutic escalation (OR 0.83 [95% CI, 0.72, 0.95]) compared to White patients, while also being 28% less likely to be therapeutically deescalated (OR 0.72 [95% CI, 0.68, 0.77]). SDH was not a significant determinant of initial P2Y12 inhibitor choice or escalation or deescalation of therapy.
CONCLUSIONS: Racial disparities were most evident for Black and Hispanic patients regarding initial P2Y12 inhibitor prescribing choice and decision to escalate or de-escalate therapy. However, these disparities were not attributed to socioeconomic status. Identifying and evaluating the reasons for disparities is essential to improving post-PCI treatment for patients with ACS.
METHODS: This was a retrospective cohort study that used Medicare data from 2010 to 2021 to identify patients who underwent PCI for ACS. The rates of initiation and therapeutic escalation and deescalation of each P2Y12 inhibitor was assessed across racial and ethnic subgroups. The Social Vulnerability Index (SVI) was used to assess socioeconomic status of different ethnic groups. Baseline bleeding risk was evaluated using the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.
RESULTS: 297,599 participants met the eligibility criteria. The mean (SD) age of patients was 76.0 (6.9) years; 44.2% of patients were female. After adjusting for patient characteristics, both Black and Hispanic patients had lower odds of prasugrel or ticagrelor initiation compared to White patients; Black and Hispanic patients were 12% (OR 0.88 [95% CI, 0.85-0.92]) and 3% (OR 0.97 [95% CI, 0.94-1.01]) less likely to be initiated on ticagrelor or prasugrel, respectively. Overall 12-month escalation rates were 3% (n=4,832) and deescalation rates were 33.5% (n=23,003). Black patients were 17% less likely to undergo therapeutic escalation (OR 0.83 [95% CI, 0.72, 0.95]) compared to White patients, while also being 28% less likely to be therapeutically deescalated (OR 0.72 [95% CI, 0.68, 0.77]). SDH was not a significant determinant of initial P2Y12 inhibitor choice or escalation or deescalation of therapy.
CONCLUSIONS: Racial disparities were most evident for Black and Hispanic patients regarding initial P2Y12 inhibitor prescribing choice and decision to escalate or de-escalate therapy. However, these disparities were not attributed to socioeconomic status. Identifying and evaluating the reasons for disparities is essential to improving post-PCI treatment for patients with ACS.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR134
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)