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Mukhopadhyay A, Blecker S, Li X, Kronish IM, Chunara R, Zheng Y, Lawrence S, Dodson JA, Kozloff S, Adhikari S. Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure. JAMA Netw Open 2023; 6:e2347519. [PMID: 38095897 PMCID: PMC10722333 DOI: 10.1001/jamanetworkopen.2023.47519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Medication nonadherence is common among patients with heart failure with reduced ejection fraction (HFrEF) and can lead to increased hospitalization and mortality. Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies. Objective To examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density. Design, Setting, and Participants This retrospective cohort study was conducted between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. Adult patients with a diagnosis of HF, reduced EF on echocardiogram, and a prescription of at least 1 guideline-directed medical therapy (GDMT) for HFrEF were included. Exposure Patient addresses were geocoded, and nSES was calculated using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, with higher values indicating higher nSES. Main Outcomes and Measures Medication nonadherence was obtained through linkage of health record prescription data with pharmacy fill data and was defined as proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications. Results Among 6247 patients, the mean (SD) age was 73 (14) years, and majority were male (4340 [69.5%]). There were 1011 (16.2%) Black participants, 735 (11.8%) Hispanic/Latinx participants, and 3929 (62.9%) White participants. Patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1086 participants) to 40.0% in the highest quartile (563 of 1086 participants) (P < .001). In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]). No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed. Conclusions and Relevance In this retrospective cohort study of patients with HFrEF, living in a lower nSES area was associated with higher rates of GDMT nonadherence. These findings highlight the importance of considering neighborhood-level disparities when developing approaches to improve medication adherence.
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Affiliation(s)
- Amrita Mukhopadhyay
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Saul Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Xiyue Li
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rumi Chunara
- Department of Biostatistics, NYU School of Global Public Health, New York, New York
- Department of Computer Science & Engineering, Tandon School of Engineering, New York, New York
| | - Yaguang Zheng
- NYU Rory Meyers College of Nursing, New York, New York
| | - Steven Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - John A. Dodson
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Sam Kozloff
- Department of Medicine, University of Utah, Salt Lake City
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Ramsing MS, Kraglund F, Jepsen P. Prevalence of Statin Use and Predictors of Statin Initiation Among Patients with Alcohol-Related Cirrhosis - A Danish Nationwide Cohort Study. Clin Epidemiol 2023; 15:435-446. [PMID: 37033124 PMCID: PMC10076903 DOI: 10.2147/clep.s401862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose Statins reportedly increase the survival of patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis), but this association might be confounded by socioeconomic status. We examined the prevalence of statin use and socioeconomic and demographic predictors of statin initiation and discontinuation among patients with ALD cirrhosis. Patients and Methods Using Danish nationwide healthcare registries, we examined statin use among patients diagnosed with ALD cirrhosis in 1997-2018. We computed the prevalence of statin use and incidence of statin initiation and discontinuation, and we used multivariable Cox regression to identify predictors of statin initiation and discontinuation. Results We identified 28,260 patients with ALD cirrhosis in 1997-2018. During this period, the prevalence of statin use rose sharply, reaching 19.0% in late 2018. Among patients diagnosed with ALD cirrhosis after 2010, 16.9% were using statins when they were diagnosed with cirrhosis. Among the patients who did not use statins initially, those with lower educational attainment were more likely to begin taking them than those with higher attainment. Also, cohabiting patients were more likely to begin than patients who lived alone, and employed patients were more likely to begin compared to patients outside the labour force. Among current statin users, unemployment predicted statin discontinuation. Conclusion The use of statins has become increasingly prevalent among Danish patients with ALD cirrhosis, reaching 19.0% in 2018. Employment, cohabitation, and a short education predicted statin initiation after ALD cirrhosis diagnosis, and unemployment predicted statin discontinuation. Overall, statin use was not a marker of a high socioeconomic status.
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Affiliation(s)
- Marine Sølling Ramsing
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Correspondence: Marine Sølling Ramsing, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, Tel +45 78 45 00 00, Email
| | - Frederik Kraglund
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Non-Adherence to Antidepressant Treatment and Related Factors in a Region of Spain: A Population-Based Registry Study. Pharmaceutics 2022; 14:pharmaceutics14122696. [PMID: 36559190 PMCID: PMC9782667 DOI: 10.3390/pharmaceutics14122696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Antidepressants are a commonly prescribed psychotropic medication, and their use has increased in recent years. Medication non-adherence in patients with mental disorders is associated with worse health outcomes. A population-based registry study to assess antidepressant non-adherence during 2021 has been carried out. An indirect method based on the medication possession ratio (MPR) has been utilized. Patients with a MPR under 80% were classified as non-adherent. A multivariate logistic regression to identify non-adherence predictors has been used, considering sociodemographic (age, sex, institutionalization and urbanicity) and health related variables (diagnostics, antidepressant class, multiple prescribers, and polypharmacy). In 2021, 10.6% of the Castile and Leon population used antidepressants. These patients were institutionalized (7.29%), living in urban areas (63.44%), polymedicated with multiple prescribers (57.07%), and using serotonin selective reuptake inhibitors (SSRIs) (54.77%), other antidepressants (46.82%) or tricyclic antidepressants (TCAs) (13.76%). Antidepressants were prescribed mainly for depression (36.73%) and anxiety (29.24%). Non-adherence to antidepressants was more frequent in men (20.56%) than in woman (19.59%) and decreased with increasing age (32% up to 17 years old vs. 13.76% over 80 years old). TCAs were associated with the highest prevalence of non-adherence (23.99%), followed by SSRIs (20.19%) and other antidepressants (18.5%). Predictors of non-adherence in patients on antidepressants were: living in urban areas, using TCAs, and pain occurrence. Non-adherence to antidepressants decreases with aging. Being female, institutionalization, being polymedicated and having depression/anxiety alongside another psychiatric diagnosis are protective factors against non-adherence. The MPR is a robust indicator for the clinician to identify non-adherent patients for monitoring, and adopt any necessary corrective actions.
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Raeisi-Giglou P, Jabri A, Shahrori Z, Sallam S, Alhuneafat L, Al-Abdouh A, Mhanna M, Kumar A, Abu Omar Y, Yousaf A, Tarabichi Y, Siraj A, Kondapaneni M. Disparities in the Prescription of Statins in the Primary Care Setting: A Retrospective Observational Study. Curr Probl Cardiol 2022; 47:101329. [PMID: 35870548 DOI: 10.1016/j.cpcardiol.2022.101329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the high disease burden of atherosclerosis, evidence exists for the disparity in the prescription of guideline-indicated medications between genders, racial groups, socioeconomic groups, and ages. We aim to perform a retrospective study looking at the disparity in statin prescription for primary and secondary prevention in these groups. METHODS Data were collected from a single center and included patients with an LDL level> 190 mg/dL, diagnosis of diabetes mellitus with LDL level >70 mg/dL, and diagnosis of cardiovascular disease regardless of LDL level. Patients older than 75 or younger than 21 were excluded from the study. Complex samples multivariable logistic and linear regression models were used to calculate the adjusted odds ratio and 95% confidence interval. RESULTS The total study population was n=56,995. Of those, 57.89% (n=32,992) were female. Only 59.56 % of these patients for whom statin therapy was indicated received it. Most patients were White (53.21%) followed by African Americans (35.98%), Asians (2.43%), American Indian/Native Alaskans (0.40%), and Native Hawaiian/Pacific Islander (0.18%). There is a clear disparity in statin prescription favoring males, the elderly, and people of white ethnicity. Interestingly, Asians were more likely to be prescribed statins as opposed to whites. Self-pay patients were more likely to receive statins than patients on Medicare. CONCLUSION Despite being indicated, Statins are underprescribed. Disparities based on race, gender, and insurance type mirror previous trends in the literature. Some results have shown a reversal in trends such as the higher prescription for Asian-Americans. Multiple patient-specific, provider-related, institutional factors might explain these disparities and must be investigated.
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Affiliation(s)
- Pejman Raeisi-Giglou
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA.
| | - Zaid Shahrori
- Faculty of Medicine, Hashemite University, Amman, Jordan
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, OH, USA
| | | | - Adnan Yousaf
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Yasir Tarabichi
- Center for Clinical Informatics, Division of Pulmonary Critical Care and Sleep Medicine, The MetroHealth System, OH, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Meera Kondapaneni
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
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Learnihan V, Schroers RD, Coote P, Blake M, Coffee NT, Daniel M. Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus. SSM Popul Health 2022; 17:101013. [PMID: 35106360 PMCID: PMC8784336 DOI: 10.1016/j.ssmph.2021.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022] Open
Abstract
Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence. Medication adherence is a problem amongst Type 2 Diabetes patients on Medicaid. Social and contextual factors' influence on medication adherence is underexplored. Higher social vulnerability is associated with non-adherence to biguanides. Adopting spatial analysis techniques enables geographic targeting of health risk.
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Affiliation(s)
- Vincent Learnihan
- Health Research Institute, University of Canberra, Australia
- Corresponding author. MPH Health Research Institute, University of Canberra, Building 23 Office B32, University Drive, Bruce, ACT, 2617, Australia.
| | | | - Philip Coote
- Health Research Institute, University of Canberra, Australia
| | - Marcus Blake
- Health Research Institute, University of Canberra, Australia
| | - Neil T. Coffee
- Health Research Institute, University of Canberra, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia
- South Australian Health & Medical Research Institute, Australia
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Guadamuz JS, McCormick CD, Choi S, Urick B, Alexander GC, Qato DM. Telepharmacy and medication adherence in urban areas. J Am Pharm Assoc (2003) 2021; 61:e100-e113. [DOI: 10.1016/j.japh.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023]
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Sigglekow F, Horsburgh S, Parkin L. Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users. PLoS One 2020; 15:e0242424. [PMID: 33211724 PMCID: PMC7676659 DOI: 10.1371/journal.pone.0242424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. METHODS Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. RESULTS Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51-1.59) times as likely to be adherent and 0.67 (95% CI 0.65-0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. CONCLUSION Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.
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Affiliation(s)
- Finn Sigglekow
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
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