Demographic, Geographic, and Clinical Characteristics Associated with Receipt of Influenza Outpatient Oral Antiviral Treatment in Commercially Insured US Patients: An Exploration of Potential Health Disparities

Abstract

Background: Marginalized groups have been shown to experience a greater portion of the annual morbidity of influenza in the US. Identifying characteristics associated with receipt of outpatient oral antiviral treatment (OOAT) is important to determine if similar disparities exist with prescribing of these treatments.Objective: To identify demographic, geographic, and clinical characteristics associated with OOAT in commercially insured US beneficiaries with influenza. Methods: We conducted a retrospective cohort study using IBM Marketscan® commercial claims to identify unique influenza cases between May 1, 2016 and April 30, 2019. For each annual cohort, odds of OOAT were determined for association with age, sex, level of rurality, region, health plan type, employment classification (hourly/salary), Charlson Comorbidity Index (CCI) score, influenza vaccination, and presence of a respiratory condition. Annual cohorts were analyzed separately for adults and children/adolescents. Results: Across all annual cohorts and ages, females, those whose primary beneficiary was paid hourly, and those who were not vaccinated against influenza all had lower odds of receiving OOAT. Adult beneficiaries living in more rural areas also had lower odds of OOAT in all annual cohorts, whereas no such association was seen in beneficiaries <18 years of age. Across all ages, at least 25% decreased odds of OOAT were observed for those enrolled in high deductible health plans (HDHP) as compared to those enrolled in any other type of health plan in the total study population, except for adults enrolled in HDHPs compared to adults enrolled in basic medical coverage plans. Conclusion: Generally, lower odds of receiving an antiviral were seen in beneficiaries who were female, with a primary beneficiary paid hourly, and enrolled in a high deductible health plan. Adult beneficiaries living in more rural areas had lower odds of OOAT suggesting that disparities may exist in this context. Future research capturing characteristics that better represent marginalization is needed to more definitely determine if disparities exist in oral influenza antiviral treatment.