Marcee E Wilder1, Zhanonian Zheng2, Scott L Zeger3, Angelo Elmi4, Richard J Katz5, Yixuan Li2, Melissa L Mccarthy1,2. 1. Department of Emergency Medicine (M.E.W., M.L.M.), The George Washington University, Medical Faculty Associates, Washington, DC. 2. Department of Health Policy and Management (Z.Z., Y.L., M.L.M.), The George Washington University, Washington, DC. 3. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.L.Z.). 4. Department of Epidemiology and Biostatistics (A.E.), Milken Institute School of Public Health, The George Washington University, Washington, DC. 5. Division of Cardiology (R.J.K.), The George Washington University, Medical Faculty Associates, Washington, DC.
Abstract
BACKGROUND: Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension. METHODS: We conducted a posthoc subgroup analysis of 3044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of hypertension based on their Medicaid claims during a 24-month period before study enrollment. We calculated the proportion of days covered 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 hypertension cohort into 4 social risk groups based on their response profiles to the SDH variables. We compared the mean proportion of days covered 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. RESULTS: The nonrandom sample was predominately Black (93%), female (62%) and had completed high school (77%). The mean proportion of days covered 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 2 groups with the most social risks were 36% (adjusted odds ratio=0.64 [95% CI, 0.53-0.78]) and 20% (adjusted odds ratio=0.80 [95% CI, 0.70-0.93]) less adherent to their hypertension therapy compared with participants in the group with the fewest social risks. CONCLUSIONS: Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.
BACKGROUND: Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension. METHODS: We conducted a posthoc subgroup analysis of 3044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of hypertension based on their Medicaid claims during a 24-month period before study enrollment. We calculated the proportion of days covered 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 hypertension cohort into 4 social risk groups based on their response profiles to the SDH variables. We compared the mean proportion of days covered 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. RESULTS: The nonrandom sample was predominately Black (93%), female (62%) and had completed high school (77%). The mean proportion of days covered 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 2 groups with the most social risks were 36% (adjusted odds ratio=0.64 [95% CI, 0.53-0.78]) and 20% (adjusted odds ratio=0.80 [95% CI, 0.70-0.93]) less adherent to their hypertension therapy compared with participants in the group with the fewest social risks. CONCLUSIONS: Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.
Entities:
Keywords:
hypertension; medication adherence; population; social determinants of health
Authors: Dean Schillinger; Lauren R Barton; Andrew J Karter; Frances Wang; Nancy Adler Journal: Public Health Rep Date: 2006 May-Jun Impact factor: 2.792
Authors: M H D Wasem Alsabbagh; Mark Lemstra; Dean Eurich; Lisa M Lix; Thomas W Wilson; Erin Watson; David F Blackburn Journal: Value Health Date: 2014-03 Impact factor: 5.725
Authors: Julie C Lauffenburger; Thomas Isaac; Romit Bhattacharya; Thomas D Sequist; Chandrasekar Gopalakrishnan; Niteesh K Choudhry Journal: Am J Cardiol Date: 2019-11-07 Impact factor: 2.778
Authors: William M Schultz; Heval M Kelli; John C Lisko; Tina Varghese; Jia Shen; Pratik Sandesara; Arshed A Quyyumi; Herman A Taylor; Martha Gulati; John G Harold; Jennifer H Mieres; Keith C Ferdinand; George A Mensah; Laurence S Sperling Journal: Circulation Date: 2018-05-15 Impact factor: 29.690
Authors: Melissa L McCarthy; Zhaonian Zheng; Marcee E Wilder; Angelo Elmi; Paige Kulie; Samuel Johnson; Scott L Zeger Journal: Med Care Date: 2021-03-01 Impact factor: 3.178