Background/Purpose: Given high cardiovascular disease (CVD) risks in SLE patients, lipid testing and statin prescription are widely advocated for those with elevated risks. We examined rates of lipid testing and statin prescription filling among SLE patients within Medicaid in recent years.  

Methods: Within Medicaid Analytic eXtract (MAX), containing billing claims from 2007-10 for Medicaid patients from the 29 most populated US states, we identified patients aged 18-65 years with prevalent SLE (>3 ICD-9 codes of 710.0, >30 days apart). We required 6 months of continuous Medicaid enrollment (baseline period) prior to the 3^rdcode (index date). Baseline data included age, year, sex, race/ethnicity, US region of residence. Subjects were followed from index date until death, Medicaid disenrollment or end of follow-up (12/31/2010). Within claims, CPT codes identified lipid testing and NDC codes identified statin prescription filling. We calculated rates per 1000 person-years for lipid testing and statin prescription filling, and rate ratios (with 95% CIs) to compare rates between sociodemographic groups. We tested for trends in lipid testing and statin prescription rates over time using Cochrane Armitage tests.    

Results: Of 37,999 patients with prevalent SLE, 93% were female. Mean age was 41.2 (+ 12.1) years. Race/ethnicity were: 42% Black, 36% White, 16% Hispanic, 2% Native American. Mean follow-up was 19.4 (+ 12.7) months; 746 patients died. In the entire cohort, 11,969 patients (32%) had >1 lipid testing and 6885 (18%) had >1 filled statin prescription. Lipid testing did not differ by sex, but statin prescription was slightly more frequent among men than women. The highest rates of lipid testing were seen among Hispanic and Asian patients (vs. White), older patients (ages 55-65 vs. younger), those living in the West (vs. other regions), and those receiving corticosteroids (vs. not). (Table) The highest rates for filled statin prescriptions were observed in older patients (ages 55-65 vs. younger), and those receiving corticosteroids. Black and Native American patients had lower rates of both lipid testing and statin prescription (vs. White patients). No geographic variation in statin prescribing was seen. Rates of both lipid testing (from 235.1 [227.3, 243.2] to 474.6 [450.9, 499.5] per 1000 person-years, p trend <0.0001) and statin prescription (from 81.7 [77.7, 86.0] to 286.4 [268.4, 305.5] per 1000 person-years, p trend <0.0001) increased significantly between 2007-10.

Conclusion: In this large SLE cohort, 32% of patients had >1 lipid testing and 18% filled > 1 statin prescription between 2007-10. Rates of both lipid testing and statin prescription increased significantly during this time. Rates were higher among older patients and those on corticosteroids. Given high CVD and mortality risks among Black and Native American SLE patients, it is noteworthy that these groups had low rates of lipid testing and statin prescriptions. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rates-of-lipid-testing-and-statin-prescription-filling-among-u-s-medicaid-recipients-with-sle-2007-2010/