Although Medicaid recipients with systemic lupus erythematosus (SLE) have an elevated risk for cardiovascular disease compared with age- and sex-matched Medicaid recipients with diabetes, individuals with SLE receive significantly less lipid testing and fill fewer statin prescriptions, according to the results of a large cohort study published in Arthritis Care & Research.
The investigators identified US Medicaid beneficiaries between 18 and 65 years with prevalent SLE who were residing in 29 states from 2007 to 2010. Each patient with SLE was age- and sex-matched with 2 Medicaid recipients with diabetes and 4 general Medicaid recipients without SLE or diabetes. They compared the proportions of individuals in each cohort who had received ≥1 lipid test and ≥1 statin prescription during a 1-year follow-up period.
Overall, 3 Medicaid patient cohorts were identified: 25,950 patients with SLE, 51,900 patients with diabetes, and 103,800 individuals without SLE or diabetes. Lipid testing was conducted in 24% of participants with SLE, 43% of participants with diabetes, and 16% of participants with neither condition. In addition, statin prescriptions were dispensed in 11% of individuals with SLE, 33% of those with diabetes, and 7% of those with neither condition.
Patients with SLE were 66% less likely (odds ratio [OR], 0.34; 95% CI, 0.34-0.35) to have their lipid levels tested and 82% less likely (OR, 0.18; 95% CI, 0.18-0.18) to have a statin prescription filled compared with patients with diabetes. Individuals with SLE were also less likely (OR, 0.89; 95% CI, 0.84-0.94) to fill a statin prescription compared with the general Medicaid population.
The investigators concluded that because preventive care for Medicaid patients with SLE is not consistently performed, efforts should be made to establish and disseminate clear evidence-based guidelines for improving care and outcomes among this high-risk population.
Disclosures: Dr Costenbader received research support from National Institutes of Health, Rheumatology Research Foundation, Lupus Foundation of America, Pfizer, Biogen-Idec, Merck, GlaxoSmithKline. Dr Feldman received research support from the National Institute of Health.
Chen SK, Barbhaiya M, Fischer MA, et al. Lipid testing and statin prescription among Medicaid recipients with systemic lupus erythematosus, diabetes mellitus and the general Medicaid population [published online April 12, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23574