Background/Purpose:  We have recently found that rates of myocardial infarction (MI) are similar among individuals with SLE and those with diabetes mellitus (DM) in a nationwide cohort of Medicaid recipients. Given high cardiovascular disease (CVD) risks in both SLE and DM patients, lipid testing is widely advocated for both groups. We investigated rates of lipid testing and statin prescriptions among SLE and DM patients within Medicaid.

Methods:  Within Medicaid Analytic eXtract (MAX), with billing claims from 2007-2010 for patients from the 29 most populous US states, we identified patients aged 18-65 years with prevalent SLE (>3 ICD-9 codes for SLE, >30 days apart), and a 1:2 age- and sex-matched DM cohort (>3 ICD-9 codes for DM, >30 days apart). We required 6 months of continuous Medicaid enrollment (baseline period) prior to the 3^rd diagnosis code (index date). Subjects were followed from index date until death, Medicaid disenrollment or end of follow-up (12/31/2010). Within claims, we used CPT codes to identify lipid testing and NDC codes to identify statin prescriptions. We calculated rates per 100 person-years for lipid testing (>1 per person) and statin prescriptions (> 1 per person), and rate ratios (with 95% CIs) adjusted for baseline demographics and CVD using Poisson regression to compare rates (DM=referent).

Results:  32,089 SLE patients were matched to 64,178 DM patients; 92% were female and mean age was 41.3 (+ 12.1) years in both cohorts. Mean years of follow-up from index date was 1.68 (+1.03) for SLE, and 1.81 (+1.08) for DM. Baseline CVD covariates for SLE vs. DM cohorts were similar for MI (0.90 vs. 0.67%), angina (2.19 vs. 2.08%), old MI (0.89 vs. 0.67%), PCI (2.29 vs. 1.61%), CABG (0.18 vs. 0.12%), CVA (2.23 vs. 0.14%), and presence of any any CVD (4.62 vs. 3.57%). Rates (per 100 person years) of lipid testing increased from 22.2 to 44.1 for SLE and 38.2 to 59.1 for DM and statin prescription increased from 7.0 to 23.4 for SLE and 24.6 to 57.9 for DM between 2007 and 2010. Unadjusted rates (per 100 person years) for lipid testing were 25.8 (95% CI 25.3-26.3) for SLE and 41.6 (95% CI 41.1-42.0) for DM, and for statin prescription were 9.1 (95% CI 8.8-9.4) for SLE and 27.6 (95% CI 27.3-28.0) for DM. The highest rates of lipid testing and statin prescriptions were found among Asians and lowest rates were seen among Native Americans for both SLE and DM. After adjusting for age, race/ethnicity, sex, region, socioeconomic status, calendar year, and CVD at baseline, the rate ratios in SLE compared to DM patients were 0.61 (95% CI 0.60-0.63) for lipid testing and 0.32 (95% CI 0.31-0.34) for statin prescriptions.

Conclusion: Rates for lipid testing and statin prescriptions increased in both SLE and DM cohorts during the study period and were highest among older patients and those with baseline CVD. Although DM and SLE confer similar risk of CVD, in this cohort, lipid testing rates were 40% lower and statin prescription rates were 70% lower in patients with SLE compared to DM.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rates-of-lipid-testing-and-statin-prescriptions-among-sle-and-diabetes-mellitus-patients-in-a-nationwide-medicaid-cohort/