摘要：Objectives. We explored possible disparities in seasonal influenza treatment in Georgia's disabled Medicaid population. We sought to determine whether racial/ethnic, geographic, or gender disparities existed in antiviral drugs usage in the treatment of influenza. Methods . Medicaid claims were analyzed from 69 556 clients with disabilities enrolled in a Georgia Medicaid disease management program. Results . There were 519 patients who met inclusion criteria (i.e., adults aged 18–64 years with an influenza diagnosis on a 2006 or 2007 Medicaid claim). Roughly one third (36.2%) of patients were classified as African American, 44.5% as White, and 19.3% as “other.” Most patients had 2 or more comorbid chronic diseases. Antivirals were used in only 14.5% of patients diagnosed with influenza. Treatment rates were nearly 3 times higher for White patients (19.5%) than for African American patients (6.9%). Conclusions . Our analysis suggests limited use of antiviral treatment of influenza overall, as well as significant racial disparities in treatment. Additional studies are needed to further explore this finding and its implications for care of racial/ethnic minority populations during seasonal influenza and for effective pandemic influenza planning for racial/ethnic minority populations. Influenza is a highly contagious viral disease of the respiratory system. It can lead to serious complications and can result in death. 1 According to the US Centers for Disease Control and Prevention (CDC), 5% to 20% of the population of the United States acquires influenza each year. 2 Additionally, 200 000 are hospitalized and 36 000 die as a result of the complications from influenza. 2 Populations vulnerable to complications include children, the elderly, racial and ethnic minority populations, persons with disabilities, and persons with chronic diseases. 3 – 5 Influenza can be prevented with annual immunizations, and it can be effectively treated with disease-modifying antiviral drugs if diagnosed within 48 hours of initial symptoms. 1 , 6 , 7 Although prevention is the best option, many individuals do not receive annual immunizations. Rates of influenza immunization vary across racial and ethnic populations. Data from the National Immunization Survey (NIS)–Adult 2007 (for the 2006–2007 season) show influenza immunization coverage for those aged 18 to 49 years among 40.9% of Whites, compared with 30.9% of African Americans and 25.6% of Hispanics. 8 National Health Interview Survey (NHIS) Early Release data from 2008 indicate that among those 65 years and older, only 49.3% of African Americans and 55.4% of Hispanics had received influenza immunizations, compared with 71% of Whites. 9 Factors contributing to lower rates of immunizations among different races and ethnicities include limited access to health care, personal beliefs, and anticipated negative side effects. 10 One study examined the disparity between African Americans and Whites, in which African Americans were less likely to receive an annual influenza immunization. 11 Reasons for the disparity were in part attributed to low perceptions of susceptibility to influenza on the part of American Americans and the subsequent view that an influenza immunization is not needed. Additional reasons include feared side effects of the immunization, including the possible acquisition of influenza as a result of the vaccination. Those African Americans who were more receptive to receiving an annual influenza immunization were of a higher income and had a greater perception of susceptibility to influenza. 11 The widespread existence of racial and ethnic health disparities has been well documented and remains a national public health concern. 12 – 14 Health disparities are not limited to persons without access to health care; they have been documented in persons with access to both Medicare and Medicaid benefits. 15 , 16 Disparities in infectious diseases have been widely documented and persist both domestically and globally. 17 , 18 Disparities in influenza immunization among racial and ethnic populations raise questions about whether disparities might also exist in influenza treatment. Treatment of influenza within the first 48 hours reduces both the recovery time and the severity of the illness. 6 In an influenza pandemic, it is anticipated that the development of an effective vaccine to counter the pandemic strain of influenza will take 6 to 8 months. 19 As a result, the treatment of influenza with the antiviral drugs oseltamivir and zanamivir will be a first line of defense for patients with influenza. 1 , 7 However, the rates of prescribing antivirals for treatment of influenza in the United States are not known. One national study found that physicians prescribed antivirals to 19% of patients diagnosed with influenza. 20 Linder et al. noted that “it is impossible to be certain whether this represents underprescribing, overprescribing, or appropriate prescribing.”20(p534) Examining patients' receptivity to antiviral medications, one study of patient knowledge and attitudes about antiviral medication found patients to be ill informed about antiviral medication and its benefits, with medication cost a potential barrier to treatment. 21 With the threat of an influenza pandemic occurring at any time, it is a public health priority to assess potential treatment disparities, especially in those most susceptible to contracting influenza. 1 , 22 Examining the treatment of influenza in the Medicaid population, specifically persons with disabilities, provides a vehicle to assess such potential disparities. Studying Medicaid claims data is useful because patients under Medicaid all have the same health insurance, as well as the same prescription coverage for medication. 23 Although health disparities in the receipt of influenza immunizations have been noted, very little research has been conducted to explore disparities in the use of pharmacological treatments for influenza. We undertook to examine possible racial/ethnic, geographic, and gender disparities in the treatment of influenza among Medicaid patients.
