Differential Impact of Longitudinal Medication Non-Adherence on Mortality by Race/Ethnicity among Veterans with Diabetes

Abstract

OBJECTIVE:To examine the differential effect of medication non-adherence over time on all-cause mortality by race/ethnicity. RESEARCH DESIGN AND METHODS: Data on a longitudinal cohort of veterans with type 2 diabetes was examined. The main outcome was time to death. Primary independent variables were race/ethnicity and mean medication possession ratio (MPR) categorized into quintiles over the study period. Cox regression was used to model the association between time to death and MPR quintiles and race/ethnicity, adjusting for relevant covariates. RESULTS: The cohort of 629,563 veterans was followed for 5 years. After adjusting for all covariates, the hazard ratios (HR) for subjects in the lowest versus highest MPR quintile was 12.21 (95 % CI 11.89, 12.55) for nonHispanic white (NHW), 10.01 (95 % CI 9.18, 10.91) for non-Hispanic black (NHB), 12.65 (95 % CI 11.10, 14.43) for Hispanic and 10.41 (95 % CI 9.06, 11.96) for Other race veterans. Furthermore, type of diabetes therapy (oral versus insulin) maintained a significant relationship with mortality that varied by racial/ethnic group. CONCLUSIONS: This study demonstrates the differential impact of medication non-adherence on mortality by race. It also demonstrates that type of diabetes therapy (insulin with or without oral agents) is associated with mortality and varies by racial/ethnic group.

Self-Care Disparities Among Adults with Type 2 Diabetes in the USA

“…Eight of the 12 studies testing unadjusted disparities found NHBs[62–66; 68; 72] and, separately, Hispanics[62; 63; 65–67] were less adherent in taking medications than NHWs. Three of the six studies testing adjusted disparities found NHBs[62; 68; 70] and, separately, Hispanics[62; 70] were less adherent to medications than NHWs.…”

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study

“…Low socioeconomic status, low health literacy, and racial/ethnic and cultural differences have been shown to play a role in nonadherence in several oncologic and nononcologic settings. [26][27][28][29][30][31] Thus, low health literacy explained the racial disparities in medication adherence among African-American youth with diabetes. 30 Furthermore, poor adherence among African Americans, Asian Americans, and Hispanics with hypertension improved by reducing patient copayments, improving access to medications, and optimizing choice of therapy.…”

“…41 Furthermore, medication nonadherence is associated with an increase in all-cause mortality. 31 Although outpatient oral 6MP treatment is relatively inexpensive, salvage treatment of relapsed ALL is expensive, associated with extensive morbidity, and largely unsuccessful, thus creating a critical need to develop measures to enhance adherence to oral 6MP.…”

Impact of diagnosed depression on healthcare costs in adults with and without diabetes: United States, 2004–2011

“…Binary indicators of co-morbidities were based on a positive response to a question “Have you ever been diagnosed with…” Cardio Vascular Disease (CVD) indicates a positive response to a question “Have you ever been diagnosed with coronary heart disease or angina or myocardial infarction or other heart diseases?” Previous studies showed that the binary indicator of disease is more effective in accounting for disease burden. (26, 27) Race/ethnic groups are categorized as: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic or others. Education was categorized as: less than high school (≤ grade 11), high school (grade 12) and college or more (grade ≥ 13).…”