Table 1.
Baseline characteristics of initiators of antihypertensive monotherapy among Medicare fee-for-service beneficiaries over 65 years of agea
BEFORE WEIGHTINGb | AFTER WEIGHTINGb | ||||||
---|---|---|---|---|---|---|---|
ACEI/ARB, % | THZ, % | BB, % | CCB, % | THZ, % | BB, % | CCB, % | |
N 111,533 | N 29,043 | N 78,746 | N 39,905 | N 29,560 | N 78,166 | N 39,687 | |
Demographics | |||||||
Age | |||||||
66–75 | 60 | 60 | 53 | 49 | 58 | 60 | 59 |
76–85 | 29 | 29 | 33 | 33 | 30 | 30 | 30 |
85+ | 10 | 11 | 15 | 17 | 11 | 11 | 11 |
Sex (male) | 37 | 25 | 36 | 32 | 38 | 37 | 36 |
Race | |||||||
Whites | 83 | 85 | 87 | 79 | 83 | 83 | 83 |
Blacks | 6.4 | 8.4 | 5.4 | 11 | 6.1 | 6.5 | 6.4 |
Others | 10 | 6.5 | 7.5 | 10 | 10 | 11 | 10 |
Year of drug initiation | |||||||
2007 | 7.4 | 8.5 | 7.8 | 7.1 | 8.2 | 7.8 | 7.1 |
2008 | 18 | 20 | 18 | 17 | 20 | 18 | 17 |
2009 | 17 | 18 | 16 | 17 | 19 | 16 | 17 |
2010 | 17 | 16 | 16 | 17 | 17 | 16 | 17 |
2011 | 17 | 16 | 16 | 17 | 16 | 16 | 17 |
2012 | 17 | 15 | 17 | 17 | 15 | 17 | 17 |
2013 | 7.5 | 6.4 | 7.6 | 8.2 | 6.0 | 7.7 | 8.4 |
Comorbidities | |||||||
Diabetes mellitus | 39 | 17 | 25 | 26 | 40 | 38 | 38 |
Diabetes nephropathy | 2.0 | 0.4 | 1.5 | 2.1 | 2.5 | 2.0 | 1.9 |
Diabetes neuropathy | 6.1 | 2.3 | 4.0 | 3.9 | 7.2 | 6.3 | 6.4 |
Diabetes retinopathy | 4.9 | 1.6 | 2.9 | 2.8 | 5.9 | 5.0 | 5.0 |
Heart failure | 11 | 6.9 | 16 | 15 | 13 | 12 | 12 |
Myocardial infarction | 0.5 | 0.2 | 1.9 | 0.5 | 0.6 | 0.5 | 0.6 |
Emphysema | 3.0 | 3.0 | 3.7 | 5.7 | 3.3 | 3.0 | 3.2 |
Chronic bronchitis | 16 | 14 | 17 | 23 | 17 | 16 | 16 |
Gastrointestinal diseases | 0.8 | 0.9 | 1.2 | 1.0 | 0.9 | 0.8 | 0.8 |
Comedications | |||||||
Metformin | 17 | 4.5 | 6.3 | 5.0 | 18 | 16 | 17 |
Sulphonylureas | 10 | 3.0 | 4.6 | 4.2 | 12 | 10 | 10 |
Thiazolidinediones | 4.8 | 1.4 | 1.8 | 1.5 | 6.1 | 4.8 | 5.1 |
Other oral anti-hyperglycemic drugs | 3.2 | 0.9 | 1.4 | 1.2 | 4.2 | 3.4 | 3.4 |
Insulin | 6.9 | 2.0 | 4.1 | 4.5 | 8.7 | 7.0 | 7.3 |
Statins | 40 | 30 | 37 | 31 | 40 | 39 | 40 |
NSAIDsc | 18 | 20 | 16 | 17 | 19 | 19 | 19 |
Aspirinc | 1.5 | 1.4 | 1.9 | 1.9 | 1.6 | 1.6 | 1.6 |
Healthcare utilization | |||||||
Colonoscopy | 8.7 | 9.3 | 9.3 | 8.3 | 8.6 | 8.9 | 8.7 |
Fecal occult blood test | 9.3 | 10 | 9.2 | 8.4 | 9.4 | 9.3 | 9.4 |
Hospital admissions (≥1) | 21 | 16 | 35 | 35 | 24 | 22 | 22 |
Physician office visits (≥1) | 92 | 93 | 91 | 89 | 93 | 92 | 92 |
ACEI – Angiotensin Converting Enzyme Inhibitors, ARB – Angiotensin Receptor Blockers, BB – beta blockers, THZ – thiazide Diuretics, BB – Beta Blockers, CCB – Calcium Channel Blockers, SD – standard deviations
Baseline was 12 months before the first prescription date. All potential confounders were assessed during this 12-months (6 months for comedications) before the first prescription.
Propensity score weighting was implemented by the stabilized morbidity ratio weighting where patients were weighted to reflect the covariate distributions in the ACEI/ARB population. ACEI/ARB cohort was given a weight of 1 and each comparator PS/(1-PS) * (1-prev)/prev, in which PS is the propensity score and prev is the marginal prevalence (proportion) of ACEI/ARB users in the study population.
NSAIDs and Aspirin use might not be captured well in the claims data since most of these agents are available over the counter.