Abstract P022: The Geographic Variations In Hypertension Medication Adherence

Abstract

Objective: Hypertension (HTN) affects 47% of adults in the United States (US). Medication adherence is difficult to achieve due to its benign course. This study aims to characterize the difference in HTN medication adherence between major regions of the US and the incongruity between urban and rural areas. Methods: This is a cross-sectional study consisting of 11,494 persons, representing over 71 million adults in the US, with a diagnosis of HTN. Data was obtained from the National Health Interview Survey in 2020. Variables include HTN medication adherence, access to regular care, household region, and urban-rural classification as defined by the National Center for Health Statistics. Chi-square test and logistic regression was used to compare the study groups. Results: HTN medication adherence was 75.6% in large urban (LU), 81.5% in large fringe urban (FU), 81.1% in medium urban (MU), and 83.3% in nonmetro (NM) areas [p < 0.001]. Using urban as the baseline comparison for a logistic regression model, a statistically significant difference was observed between LU and each individual group [p < 0.001] . This association remained significant when adjusting for covariates of BMI, marital status, insurance status, race, and age [p < 0.001]. Also, patients in LU were least likely to have a regular healthcare provider at 94.7% followed by 95.9% in FU, and 97.0% in MU and NM [p < 0.01]. Adherence across U.S. regions, defined as Northeast, South, Midwest, and West was statistically significant [p <0.01]. On logistic regression, West had a significantly lower adherence rate at 76.6% when compared to other regions [OR 0.69; 95% CI 0.56, 0.85; p < 0.05]. The odds increased further when adjusting for covariates of BMI, marital status, insurance status, race, and age [AOR 0.74; 95% CI 0.58, 0.95; p < 0.05]. Conclusion: Urban areas are associated with lower rates of HTN medication adherence with increasing adherence in smaller communities. Additionally, Western US is correlated with a lower adherence rate compared to other regions. Further investigation into sources for this discrepancy is warranted, including potential differences in public health campaigns, prescribing practices, and follow up care. This knowledge could assist in the development of targeted solutions.