Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort.
Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort.
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DOI：
10.1161/circoutcomes.121.008150
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Mccarthy ML
中科院分区：
文献类型：
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作者：
Wilder ME;Zheng Z;Zeger SL;Elmi A;Katz RJ;Li Y;Mccarthy ML
关于医疗补助受益人高血压（HTN）的健康社会决定因素（SDH）和药物依从性之间的关系知之甚少。我们对3，044名成年医疗补助受益人进行了事后亚组分析，这些受益人参加了父母前瞻性队列研究，并在研究入组前24个月内根据他们的医疗补助索赔诊断为HTN。我们使用处方索赔数据计算了研究入组后前12个月内至少一种抗高血压药物的覆盖天数比例（PDC）。我们在研究入组时测量了许多SDH，并根据他们对SDH变量的反应概况将HTN队列分为四个社会风险组。我们比较了不同水平的SDH因子的平均PDC。我们使用广义线性模型，对社会风险组在整个随访期间每日接受抗高血压药物治疗的几率进行建模，并对年龄、性别和疾病严重程度进行调整。非随机样本主要是黑人（93%），女性（62%）和高中毕业生（77%）。不同SDH患者的平均PDC差异有统计学意义，如食物不安全（49%~ 56%）、现居时间（47%~ 57%）、吸烟状况（50%~ 56%）等。与社会风险最低的组相比，社会风险最高的两组参与者对高血压治疗的依从性分别低36%（aOR=0.64; 95% CI 0.53，0.78）和20%（aOR=0.80; 95% CI 0.70，0.93）。社会风险与医疗补助人群中抗高血压药物依从性较低相关。
Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension (HTN). We conducted a posthoc subgroup analysis of 3,044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of HTN based on their Medicaid claims during a 24-month period prior to study enrollment. We calculated the Proportion of Days Covered (PDC) by at least one antihypertensive medication during the first 12 months after study enrollment using the prescription claims data. We measured numerous SDH at the time of study enrollment and we categorized our HTN cohort into four social risk groups based on their response profiles to the SDH variables. We compared the mean PDC by the different levels of the SDH factors. We modeled the odds of being covered by an antihypertensive medication daily throughout the follow-up period by social risk group, adjusted for age, sex, and disease severity using a generalized linear model. The non-random sample was predominately black (93%), female (62%) and had completed high school (77%). The mean PDC varied significantly by different SDH such as food insecurity (49% - 56%), length of time living at present place (47% - 57%), smoking status (50% - 56%), etc. Social risk group was a significant predictor of medication adherence. Participants in the two groups with the most social risks were 36% (aOR=0.64; 95% CI 0.53, 0.78) and 20% (aOR=0.80; 95% CI 0.70, 0.93) less adherent to their hypertension therapy compared to participants in the group with the fewest social risks. Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.