Racial Disparities in Clinical Outcomes and Treatment Pattern to Chronic Diseases in the US: A Real World Study Based on Administrative Claims and Electronic Health Records Data
Author(s)
Verma V1, Brooks L2, Gaur A3, Gupta A3, Bhargava S4, Dawar V3, Pullagurla SR5, Ashra P3, Paul K3, Mishra T3, Sanyal S6, Nayyar A3
1Optum, Gurgaon, HR, India, 2Optum, Basking Ridge, NJ, USA, 3Optum, Gurugram, HR, India, 4Optum Tech, Eden Prarie, MN, USA, 5Optum, Hyderabad, India, 6Optum, Hyderabad, AP, India
Presentation Documents
OBJECTIVES: The aim of our analyses is to explore racial disparity in clinical outcomes and treatment adherence among patients with diabetes (T2DM), chronic kidney disease (CKD), and chronic heart failure (CHF).
METHODS: Severe patients with T2DM, CKD and CHF from 2017 to 2019 (using ICD-10-CM codes) were included in our study. Real world data was comprehensively used from Optum® de-identified Market Clarity database, which links EHR, and multi-payer claims data. Patients with continuous eligibility for medical and pharmacy claims in the pre- and post-index period of 12 months were considered. Laboratory test results for the specific tests of HbA1c, eGFR and LVEF were considered from the EHR data. Mean value for proportion of days covered (PDC) was used as a proxy for treatment adherence. A linear regression technique along with propensity score matching (PSM) was used to estimate the racial disparity.
RESULTS: Considering Caucasians as a reference and adjusting for other demographic variables, clinical outcome was found to be significantly inferior for African Americans (0.27 units; p= 0.0087) and Asians (0.42 units; p=0.0313) in T2DM. In CKD & CHF, both African Americans (-9.1 units; p<.0001), (-3.9 units; p<.0001) and Hispanics (-9.0 units; p=0.0291), (-5.77 units; p=0.0017) showed significantly inferior clinical outcomes. When compared to Caucasians, a mean PDC difference of 9% in African Americans (PDC=47%) was observed in T2D patients. Similarly in CHF, a mean PDC difference of 8% (PDC= 63%) and 5% (PDC= 67%) was observed in African Americans Hispanics respectively. Comparable findings were seen for CKD treatment modalities as well.
CONCLUSIONS: In reference to the Caucasians, a prominent trend of inferior clinical outcomes and under-treatment was observed among African Americans and Hispanics for all three chronic disease conditions.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
RWD42
Topic
Health Policy & Regulatory, Real World Data & Information Systems, Study Approaches
Topic Subcategory
Electronic Medical & Health Records, Health & Insurance Records Systems, Health Disparities & Equity
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Urinary/Kidney Disorders