A Policy Prescription for Reducing Health Disparities—Achieving Pharmacoequity

Essien, Utibe R.; Dusetzina, Stacie B.; Gellad, Walid F.

doi:10.1001/jama.2021.17764

Cited by 119 publications

(95 citation statements)

References 10 publications

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“…The rise in DOAC use is likely due to the improved safety profile and lower side effects associated with DOACs compared to warfarin [2] . As the paradigm for stroke prevention in patients with AF shifts, increasing the accessibility of anticoagulation therapy and especially to DOACs for all patients is essential to promoting pharmacoequity [29] . Given the impact of neighborhood factors on health outcomes, including social factors such as ADI in health services analyses can elucidate how neighborhood factors contribute to patient outcomes and access to care.…”

Section: Discussionmentioning

confidence: 99%

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Omole

Zhu

Garrard

et al. 2022

American Journal of Preventive Cardiology

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Section: Discussionmentioning

confidence: 99%

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Omole

Zhu

Garrard

et al. 2022

American Journal of Preventive Cardiology

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“…5 Alternative explanations include decreased access to care in communities with higher rates of racial and ethnic minority individuals, a known driver of similar disparities. 6 For example, mass vaccination sites and other community-based programs likely narrowed what otherwise might have been even greater disparities during the initial rollout. However, many such sites were closed during the booster rollout.…”

Section: Discussionmentioning

confidence: 99%

Racial and ethnic disparities in COVID-19 vaccinations in the United States during the booster rollout

Faust

Renton

Essien

et al. 2021

Preprint

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Background: We sought to quantify whether there were statistically significant disparities along race and ethnicity lines during the early rollout of Covid-19 vaccine booster doses in the United States. We also studied whether such disparities replicated or widened disparities that had already been observed during the initial series rollout as of 2 months earlier (Janssen) or 6 months earlier (Pfizer-BioNTech or Moderna), which comprised the booster-eligible population. Methods: This cross-sectional study of US adults (ages ≥18 years) used public data from US Centers for Disease Control and Prevention. The observed shares of vaccine doses for each race and ethnicity were compared to the expected shares, predicted based upon the compositions of the booster-eligible and initial series-eligible populations. Results: As of November 16, 2021, 123.5 million US adults were eligible for a booster dose of either the Pfizer-BioNTech, Moderna, or Janssen vaccines. Of these, 21.7 million had received a booster dose, among whom race and ethnicity information was available for 18.8 million booster recipients. A statistically significant higher share of Non-Hispanic White and Non-Hispanic Multiple/Other race individuals had received a booster vaccination than projected based on the composition of the booster-eligible population. A statistically significant lower share of Hispanic, Non-Hispanic American Indian/Alaskan Native, Non-Hispanic Asian, Non-Hispanic Black, and Non-Hispanic Native Hawaiian/Other Pacific Islander individuals had received a booster vaccination than expected based on the booster-eligible population. A secondary analysis of the booster-eligible population found that some of these disparities had already occurred at the time of the initial series. However, the booster campaign widened all of those disparities and added new disparities for Non-Hispanic American Indian/Alaskan Native and Non-Hispanic Native Hawaiian/Other Pacific Islander individuals. Conclusion: Disparities in Covid-19 vaccine administration on race and ethnicity lines occurred during the initial series rollout in the US. However, these disparities were not merely replicated but widened by the early booster rollout.

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“…This national distribution system serving a population with a majority of older adults with a high burden of underlying conditions who are frequently at increased risk for severe COVID-19 16 provides a unique opportunity to evaluate how these therapies have been allocated to at-risk patients infected with SARS-CoV-2, including among minority groups for whom reach of novel pharmacotherapies in the general U.S. population is often unequal. 17 Thus, we sought to describe rates and factors associated with prescription of outpatient COVID-19 pharmacotherapies during January and February 2022 when sotrovimab, a monoclonal antibody active against circulating Omicron SARS-CoV-2 variants at the time and antivirals nirmatrelvir, molnupiravir, and remdesivir were authorized for use. 8…”

Section: Introductionmentioning

confidence: 99%

Receipt of anti-SARS-CoV-2 pharmacotherapies among U.S. Veterans with mild to moderate COVID-19, January-February 2022

Bajema

Wang

Hynes

et al. 2022

Preprint

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Background: Older adults and persons with medical co-morbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19-related hospitalization and death have been authorized for use. We describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Health Administration. Methods: We conducted a retrospective cohort study among Veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during January and February 2022. We compared receipt of any COVID-19 pharmacotherapy, including sotrovimab, nirmatrelvir plus ritonavir, molnupiravir, or remdesivir versus no antiviral or monoclonal antibody treatment according to demographic characteristics, place of residence, underlying medical conditions, and COVID-19 vaccination using multivariable logistic regression. Results: During January and February 2022, 16,546 courses of sotrovimab, nirmatrelvir, and molnupiravir were allocated across the Veterans Health Administration. Among 111,717 Veterans testing positive for SARS-CoV-2, 4,233 (3.8%) received any COVID-19 pharmacotherapy, including 2,870 of 92,396 (3.1%) in January and 1,363 of 19,321 (7.1%) in February. Among a subset of 56,206 Veterans with documented COVID-19-related symptoms in the 30 days preceding positive SARS-CoV-2 test, 3,079 of 53,206 (5.5%) received any COVID-19 pharmacotherapy. Untreated Veterans had a median age of 60 years (interquartile range [IQR] 46-71 years) and median 3 underlying medical conditions (IQR 2-5). Veterans receiving any treatment were more likely to be older (adjusted odds ratio [aOR] 1.66, 95% confidence interval [CI] 1.52-1.80, 65-74 versus 50-64 years; aOR 1.67, 95% CI 1.53-1.84 =75 versus 50-64 years) and have a higher number of underlying conditions (aOR 1.63, 95% CI 1.48-1.79, 3-4 versus 1-2 conditions; aOR 2.17, 95% CI 1.98-2.39, =5 versus 1-2 conditions). Persons of Black versus White race (aOR 0.65, 95% CI 0.60-0.72) and well as persons of Hispanic ethnicity (aOR 0.88, 95% CI 0.77-0.99) were less likely to receive treatment. Conclusions and Relevance: Although supply of outpatient COVID-19 pharmacotherapies during January and February 2022 was limited, prescription of these pharmacotherapies was underutilized, and many Veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during this period did not receive treatment. Racial and ethnic minorities were less likely to receive any pharmacotherapy.

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A Policy Prescription for Reducing Health Disparities—Achieving Pharmacoequity

Cited by 119 publications

References 10 publications

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation

Racial and ethnic disparities in COVID-19 vaccinations in the United States during the booster rollout

Receipt of anti-SARS-CoV-2 pharmacotherapies among U.S. Veterans with mild to moderate COVID-19, January-February 2022

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