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Equity in the receipt of oseltamivir in the United States during the H1N1 pandemic.

Franklin, Jessica M; Choudhry, Niteesh K; Uscher-Pines, Lori; Brill, Gregory; Matlin, Olga S; Fischer, Michael A; Schneeweiss, Sebastian; Avorn, Jerry; Brennan, Troyen A; Shrank, William H.
Am J Public Health ; 104(6): 1052-8, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24825206

OBJECTIVES:

We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons.

METHODS:

In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006-May 2007, October 2007-May 2008, and October 2008-May 2010). In 19 states with county-level influenza rates reported, we controlled for disease burden.

RESULTS:

Approximately 56 million subscribers throughout the United States were included in 1 or more study periods. During pandemic flu, beneficiaries in the highest income category had 97% greater odds of receiving oseltamivir than those in the lowest category (P < .001). After we controlled for disease burden, subscribers in the 2 highest income categories had 2.18 and 1.72 times the odds of receiving oseltamivir compared with those in the lowest category (P < .001 for both).

CONCLUSIONS:

Income was a stronger predictor of oseltamivir receipt than prevalence of influenza. These findings corroborate concerns about equity of treatment in pandemics, and they call for improved approaches to distributing potentially life-saving treatments.