Racial, Ethnic, and Sex Variations in Medication Treatment
Racial, Ethnic, and Sex Variations in Medication Treatment
Purpose. Variations in the medication treatment received by racial and ethnic minorities and women and the negative health outcomes associated with these differences were examined.
Methods. Studies published between January 1990 and June 2008 were identified via electronic searches of MEDLINE, PsychINFO, International Pharmaceutical Abstracts, PubMed, and CINAHL using search terms related to race, ethnicity, sex, drug treatment, and disparity or variation. Articles were excluded if they addressed only medical or surgical care or did not include a statistical analysis of differences in drug treatment based on race, ethnicity, or sex. Data regarding the frequency of reported race, ethnic, and sex differences in medication treatment, the types of treatment differences observed, and associated health outcomes were extracted.
Results. A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy- seven percent (n = 240) of included articles revealed significant disparities in drug treatment across race, ethnicity, and sex (p < 0.05). The most frequent disparity, found in 73% of the articles studied, was differences in the receipt of prescription drugs; however, documented disparities occurred related to differences in the drugs prescribed, drug dosing or administration, and wait time to receipt of a drug. Documented outcomes associated with pharmacotherapeutic disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment (e.g., low- density-lipoprotein cholesterol, blood pressure goals), and decreased rates of survival.
Conclusion. A literature review revealed significant disparities in the medication treatment received by racial and ethnic minorities and women.
The United States spends more than any other nation in the world on health care, but despite consistent spending increases shouldered by insurers, patients, employers, and taxpayers, significant health disparities persist. The term health disparities is not universally defined; yet, most definitions include an implied, if not explicit, provision that such disparities extend beyond mere mathematical or statistical differences in measurable health-related variables. The Institute of Medicine (IOM) has defined health disparities as "differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention." Similarly, the World Health Organization described disparities as "differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust." In addition to perpetuating social and historical inequities, health disparities are often reflected in negative health outcomes, including higher mortality rates, greater burdens of disease and disability, and a reduced quality of life for those populations that experience disparate medical care and treatment.
It was not until 1985 that the U.S. Department of Health and Human Services (DHHS) established a separate Office of Minority Health. Consequently, research analyzing racial and ethnic disparities in health status, quality of care, and access proliferated and was summarized and evaluated in an IOM report published in 2003, entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In January 2000, DHHS launched Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda calling for the elimination of all health disparities, including differences that occur due to ethnicity, sex, education, income, disability, geographic location, or sexual orientation. Eliminating health disparities represents a tremendous challenge in preventing and treating diseases and improving the health and quality of life of all people.
Despite a national research agenda targeted at reducing or eliminating health disparities, little research or attention has been placed specifically on the role of pharmacy and pharmacists in reducing health disparities, particularly identifying, quantifying, and rectifying disparities related to or caused by disparate treatments with pharmaceuticals—we, the authors, have termed such differences "pharmacotherapeutic disparities." Pharmacotherapeutic disparities can encompass differences in the receipt or nonreceipt of drugs, drugs selected, dosage or intensity of treatment, method of drug delivery (e.g., oral versus injection), and wait time to drug administration. Existing literature reviews concerning racial, ethnic, and sex disparities in drug treatment have investigated disparities within a single disease or condition rather than examining overall disparities in medication treatment as the primary methodological and analytic focus. This article critically examines the research on racial, ethnic, or sex disparities in the medication management or treatment of diseases or medical conditions and introduces and applies a new term (pharmacotherapeutic disparities) for a potentially underrecognized and therefore unaddressed health care disparity.
Abstract and Introduction
Abstract
Purpose. Variations in the medication treatment received by racial and ethnic minorities and women and the negative health outcomes associated with these differences were examined.
Methods. Studies published between January 1990 and June 2008 were identified via electronic searches of MEDLINE, PsychINFO, International Pharmaceutical Abstracts, PubMed, and CINAHL using search terms related to race, ethnicity, sex, drug treatment, and disparity or variation. Articles were excluded if they addressed only medical or surgical care or did not include a statistical analysis of differences in drug treatment based on race, ethnicity, or sex. Data regarding the frequency of reported race, ethnic, and sex differences in medication treatment, the types of treatment differences observed, and associated health outcomes were extracted.
Results. A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy- seven percent (n = 240) of included articles revealed significant disparities in drug treatment across race, ethnicity, and sex (p < 0.05). The most frequent disparity, found in 73% of the articles studied, was differences in the receipt of prescription drugs; however, documented disparities occurred related to differences in the drugs prescribed, drug dosing or administration, and wait time to receipt of a drug. Documented outcomes associated with pharmacotherapeutic disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment (e.g., low- density-lipoprotein cholesterol, blood pressure goals), and decreased rates of survival.
Conclusion. A literature review revealed significant disparities in the medication treatment received by racial and ethnic minorities and women.
Introduction
The United States spends more than any other nation in the world on health care, but despite consistent spending increases shouldered by insurers, patients, employers, and taxpayers, significant health disparities persist. The term health disparities is not universally defined; yet, most definitions include an implied, if not explicit, provision that such disparities extend beyond mere mathematical or statistical differences in measurable health-related variables. The Institute of Medicine (IOM) has defined health disparities as "differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention." Similarly, the World Health Organization described disparities as "differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust." In addition to perpetuating social and historical inequities, health disparities are often reflected in negative health outcomes, including higher mortality rates, greater burdens of disease and disability, and a reduced quality of life for those populations that experience disparate medical care and treatment.
It was not until 1985 that the U.S. Department of Health and Human Services (DHHS) established a separate Office of Minority Health. Consequently, research analyzing racial and ethnic disparities in health status, quality of care, and access proliferated and was summarized and evaluated in an IOM report published in 2003, entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In January 2000, DHHS launched Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda calling for the elimination of all health disparities, including differences that occur due to ethnicity, sex, education, income, disability, geographic location, or sexual orientation. Eliminating health disparities represents a tremendous challenge in preventing and treating diseases and improving the health and quality of life of all people.
Despite a national research agenda targeted at reducing or eliminating health disparities, little research or attention has been placed specifically on the role of pharmacy and pharmacists in reducing health disparities, particularly identifying, quantifying, and rectifying disparities related to or caused by disparate treatments with pharmaceuticals—we, the authors, have termed such differences "pharmacotherapeutic disparities." Pharmacotherapeutic disparities can encompass differences in the receipt or nonreceipt of drugs, drugs selected, dosage or intensity of treatment, method of drug delivery (e.g., oral versus injection), and wait time to drug administration. Existing literature reviews concerning racial, ethnic, and sex disparities in drug treatment have investigated disparities within a single disease or condition rather than examining overall disparities in medication treatment as the primary methodological and analytic focus. This article critically examines the research on racial, ethnic, or sex disparities in the medication management or treatment of diseases or medical conditions and introduces and applies a new term (pharmacotherapeutic disparities) for a potentially underrecognized and therefore unaddressed health care disparity.