Racial and ethnic disparities in the pharmacologic management of diabetes mellitus among long-term care facility residents.

OBJECTIVE: To evaluate the prevalence of racial and ethnic disparities of antidiabetic treatment among residents of long-term care facilities in five states. RESEARCH DESIGN AND METHODS: Retrospective, cross-sectional study of 50,427 elderly nursing home residents with diabetes in New York, South Dakota, Kansas, Mississippi, and Ohio between 1993 and 1997. RESULTS: Thirty to fifty percent of residents received no antidiabetic medications. After adjusting for sociodemographic characteristics, comorbid conditions and diabetes severity, Blacks and Hispanics had lower rates of antidiabetic medication use than Whites, while Asians had slightly higher rates. For Native Americans the results were mixed, little disparity was seen when compared with Whites observed among New York nursing home residents, and while in South Dakota Native Americans had significantly lower rates of antidiabetic medication use than Whites. CONCLUSION: Although lack of information on glycemic control and non-medical treatments do not allow us to comment on quality of diabetes care, more research is needed to understand why some nursing homes residents are less likely to receive antidiabetic medication.

Racial disparities in receipt of secondary stroke prevention agents among US nursing home residents.

BACKGROUND AND PURPOSE: Although medications can significantly reduce the risk of recurrent stroke, little is known about the extent to which such therapies are given to nursing home residents. We sought to evaluate the extent to which people of color were less likely to receive pharmacological agents in the treatment of recurrent stroke while living in US nursing homes. METHODS: We identified 19 051 residents with a recent hospitalization and primary discharge diagnosis of 434 or 436 in 5 states from 1992 to 1996; of these, 7053 had concomitant conditions indicating anticoagulant therapy. We considered aspirin, dipyridamole, ticlopidine, or warfarin alone or in combination as secondary drug prevention. Generalized linear models provided estimates of the absolute difference in prevalence estimates of the receipt of agents used for the prevention of recurrent stroke between each race-ethnicity group adjusted for potential confounders. RESULTS: Variability in use of any treatment was observed by race-ethnicity ranging from 58% of American Indians receiving therapy to only 39% of Asian/Pacific Islanders. Among residents with an indication for anticoagulant therapy, the absolute estimated crude differences indicated that residents of color were less likely than non-Hispanic whites to receive warfarin. After controlling for confounding, Asian/Pacific Islanders, blacks, and Hispanics eligible for anticoagulant therapy received warfarin less often than non-Hispanic white residents. CONCLUSIONS: Overall, only half of our elderly population received any pharmacological agent for secondary prevention of stroke. Interventions designed to improve the pharmacological management of recurrent stroke regardless of race are needed in the nursing home setting.