バイタルサイン：メディケアパートD加入者における抗高血圧治療の非遵守の格差 ― アメリカ、2014年

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ホーム IMICライブラリ MMWR抄訳 2016年（Vol.65)バイタルサイン：メディケアパートD加入者における抗･･･

MMWR抄訳

2016/09/16Vol. 65 / No. 36

MMWR65(36):967－976
Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

バイタルサイン：メディケアパートD加入者における抗高血圧治療の非遵守の格差 ― アメリカ、2014年

CDCとCenters for Medicare and Medicaid Services (CMS)は、CMS Chronic Conditions Data Warehouseの2014年データより、メディケアパートDに加入し、抗高血圧薬の処方を受ける約1,850万人を対象に、抗高血圧治療の非遵守について分析を行った。抗高血圧治療の不遵守は血圧コントロール不良から有害な心血管疾患転帰を来す。処方薬のレセプトデータから、服薬率80％未満を非遵守とした場合、約490万人(26.3％)が非遵守であった。非遵守率は男性(26.7％)と女性(25.8％)で同等であり、年齢別では65～74歳：25.4％、75～84歳：27.0％、85歳以上：29.0％と年齢に伴い増加し、人種/民族別では非ヒスパニック系白人：24.3％、アジア/太平洋諸国：26.3％にて低く、アメリカインディアン/アラスカ原住民：38.8％、黒人：35.7％、ヒスパニック：33.8％にて高値であった。また、低所得補助金を受ける世帯では32.1％と補助金対象でない世帯(25.4％)に比べ高かった。地域別では南部：28.9％、西部：26.7％、北東部：24.1％、中西部：22.8％の順であり、州別ではノースダコタ州：18.7％、ウイスコンシン州：18.8％、ミネソタ州：18.9％にて低く、ワシントンDC：33.7％、ミシシッピ州：32.8％、ルイジアナ州：31.5％にて高く、また、プエルトリコ：39.6％、バージン諸島：46.9％でも高値であった。2014年の抗高血圧薬の処方数は2億1,590万件、約59億ドルの支出であり、うち21億ドル(35.6％)は加入者の負担であった(1人あたりの負担額：92ドル/年)。以上、抗高血圧薬の処方を受けるメディケアパートD加入者の1/4以上が非遵守であり、その割合は人種/民族、州および地域により異なることが示された。

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