Kendra Piper1, Joshua Richman2, Edward Faught3, Roy Martin4, Ellen Funkhouser5, Jerzy P Szaflarski6, Chen Dai7, Lucia Juarez8, Maria Pisu9. 1. Department of Gynecology and Obstetrics, Emory University, United States. Electronic address: kendra.piper@emory.edu. 2. Department of Surgery, University of Alabama at Birmingham, United States. Electronic address: jrichman@uabmc.edu. 3. Department of Neurology, Emory University, United States. Electronic address: rfaught@emory.edu. 4. Department of Neurology, University of Alabama at Birmingham, United States. Electronic address: rmartin@uabmc.edu. 5. Division of Preventive Medicine, University of Alabama at Birmingham, United States. Electronic address: efunkhouser@uabmc.edu. 6. Department of Neurology, University of Alabama at Birmingham, United States. Electronic address: jszaflarski@uab.edu. 7. Division of Preventive Medicine, University of Alabama at Birmingham, United States. Electronic address: chendai@uabmc.edu. 8. Division of Preventive Medicine, University of Alabama at Birmingham, United States. Electronic address: ljuarez@uabmc.edu. 9. Division of Preventive Medicine, University of Alabama at Birmingham, United States. Electronic address: mpisu@uab.edu.
Abstract
INTRODUCTION: Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS: In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS: Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION: About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
INTRODUCTION: Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS: In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS: Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION: About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
Authors: Richard F M Chin; Brian G R Neville; Catherine Peckham; Angie Wade; Helen Bedford; Rod C Scott Journal: Epilepsia Date: 2008-10-24 Impact factor: 5.864
Authors: R Edward Faught; Jennifer R Weiner; Annie Guérin; Marianne C Cunnington; Mei Sheng Duh Journal: Epilepsia Date: 2008-10-03 Impact factor: 5.864
Authors: Marie A Krousel-Wood; Paul Muntner; Tareq Islam; Donald E Morisky; Larry S Webber Journal: Med Clin North Am Date: 2009-05 Impact factor: 5.456
Authors: Maria Pisu; Joshua Richman; Jerzy P Szaflarski; Ellen Funkhouser; Chen Dai; Lucia Juarez; Edward Faught; Roy C Martin Journal: Epilepsia Date: 2019-06-06 Impact factor: 5.864
Authors: Samuel Waller Terman; Wesley T Kerr; Carole E Aubert; Chloe E Hill; Zachary A Marcum; James F Burke Journal: Neurology Date: 2021-12-10 Impact factor: 9.910
Authors: Samuel Waller Terman; Chun C Lin; Wesley T Kerr; Lindsey B DeLott; Brian C Callaghan; James F Burke Journal: Neurology Date: 2022-06-15 Impact factor: 11.800
Authors: Maria Pisu; Joshua Richman; Kendra Piper; Roy Martin; Ellen Funkhouser; Chen Dai; Lucia Juarez; Jerzy P Szaflarski; Edward Faught Journal: Med Care Date: 2017-07 Impact factor: 2.983