Racial, gender and geographic disparities of antiretroviral treatment among US Medicaid enrolees in 1998

• Published in: Journal of epidemiology and community health (1979) Vol. 62; no. 9; pp. 798 - 803
• Main Authors: King, W D, Minor, P, Ramirez Kitchen, C, Oré, L E, Shoptaw, S, Victorianne, G D, Rust, G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-09-2008; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD
• Subjects: Acquired immune deficiency syndrome; Adult; African Americans; Age Factors; Aged; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - statistics & numerical data; Antiretrovirals; Antivirals; Biological and medical sciences; Delivery of Health Care - statistics & numerical data; Female; General aspects; Government programs; Highly active antiretroviral therapy; Hispanics; HIV; HIV Infections - drug therapy; HIV Infections - ethnology; Humans; Lifesaving; Male; Medicaid; Medicaid - statistics & numerical data; Medical sciences; Middle Aged; Miscellaneous; Mortality; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research reports; Sex Factors; United States - epidemiology; White people; United States; North America; America; 1998; Medicine; Health insurance; Chemotherapy; Treatment; Race; Sex; Disparity; Public health; Geographical variation
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2005.045567

Background:In 1998, highly active antiretroviral therapy (HAART) was widespread, but the diffusion of these life-saving treatments was not uniform. As half of all AIDS patients in the USA have Medicaid coverage, this study of a multistate Medicaid claims dataset was undertaken to assess disparities in the rates of HAART.Methods:Data came from 1998 Medicaid claims files from five states with varying HIV prevalence. ICD-9 codes were used to identify people with a diagnosis of HIV/AIDS or AIDS-defining illness. Multivariate analyses assessed associations between age, gender, race and state of residence for antiretroviral regimens consistent with HAART, as defined by 1998 Centers for Disease Control and Prevention (CDC) guidelines.Results:Among 7202 Medicaid enrolees with a diagnosis of HIV/AIDS or AIDS, 62% received HAART and 25% received no antiretroviral therapy. Multivariate analyses showed that age, race, gender and state were all significant predictors of receiving HAART: white, non-Hispanic patients were most likely to receive HAART (68.3%), with lower rates in Hispanic and black, non-Hispanic segments of the population (59.3% and 57.5%, respectively, p<0.001). Women were less likely to receive HAART than men (51.8% vs 69.3%, p<0.001).Conclusion:Despite similar insurance coverage and drug benefits, life-saving treatments for HIV/AIDS diffused at widely varying rates in different segments of the Medicaid population. Research is needed to determine the extent to which racial, gender, interstate and region disparities currently correspond to barriers to such care.