Yun Han1, Rajiv Saran1, Steven R Erickson2, Richard A Hirth3, Kevin He4, Rajesh Balkrishnan5. 1. Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 2. University of Michigan, College of Pharmacy, USA. 3. Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 4. Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 5. University of Virginia School of Medicine, Department of Public Health Sciences, USA. Electronic address: rb9ap@virginia.edu.
Abstract
BACKGROUND: Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals' medication-taking behaviors in patients. OBJECTIVE: To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States. METHODS: The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence. RESULTS: A total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence. CONCLUSIONS: Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.
BACKGROUND: Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals' medication-taking behaviors in patients. OBJECTIVE: To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensivepatients with chronic kidney disease (CKD) in the United States. METHODS: The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence. RESULTS: A total of 70,201 hypertensive CKDpatients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence. CONCLUSIONS: Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.
Authors: Judy T Zerzan; Nancy E Morden; Stephen Soumerai; Dennis Ross-Degnan; Elizabeth Roughead; Fang Zhang; Linda Simoni-Wastila; Sean D Sullivan Journal: Med Care Date: 2006-11 Impact factor: 2.983
Authors: Carmen A Peralta; Leroi S Hicks; Glenn M Chertow; John Z Ayanian; Eric Vittinghoff; Feng Lin; Michael G Shlipak Journal: Hypertension Date: 2005-04-25 Impact factor: 10.190
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Nicole Bhave; Jennifer Bragg-Gresham; Rajesh Balkrishnan; Xue Dietrich; Ashley Eckard; Paul W Eggers; Abduzhappar Gaipov; Daniel Gillen; Debbie Gipson; Susan M Hailpern; Yoshio N Hall; Yun Han; Kevin He; William Herman; Michael Heung; Richard A Hirth; David Hutton; Steven J Jacobsen; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Csaba P Kovesdy; Danielle Lavallee; Janet Leslie; Keith McCullough; Zubin Modi; Miklos Z Molnar; Maria Montez-Rath; Hamid Moradi; Hal Morgenstern; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Christina Park; Jeffrey Pearson; Ronald Pisoni; Praveen K Potukuchi; Panduranga Rao; Kaitlyn Repeck; Connie M Rhee; Jillian Schrager; Douglas E Schaubel; David T Selewski; Sally F Shaw; Jiaxiao M Shi; Monica Shieu; John J Sim; Melissa Soohoo; Diane Steffick; Elani Streja; Keiichi Sumida; Manjula K Tamura; Anca Tilea; Lan Tong; Dongyu Wang; Mia Wang; Kenneth J Woodside; Xin Xin; Maggie Yin; Amy S You; Hui Zhou; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2018-03 Impact factor: 8.860