Ethnic Differences in 90-Day Poststroke Medication Adherence

Abstract

Background and Purpose— We assessed ethnic differences in medication adherence 3 months poststroke in a population-based study as an initial step in investigating the increased stroke recurrence risk in Mexican Americans compared with non-Hispanic whites. Methods— Ischemic stroke cases from 2008 to 2015 from the Brain Attack Surveillance in Corpus Christi project in Texas were followed prospectively for 3 months poststroke to assess medication adherence. Medications in 5 drug classes were analyzed: statins, antiplatelets, anticoagulants, antihypertensives, and antidepressants. For each drug class, patients were considered adherent if they reported never missing a dose in a typical week. The χ 2 tests or Kruskal-Wallis nonparametric tests were used for ethnic comparisons of demographics, risk factors, and medication adherence. A multivariable logistic regression model was constructed for the association of ethnicity and medication nonadherence. Results— Mexican Americans (n=692) were younger (median 65 years versus 68 years, P <0.001), had more diabetes mellitus ( P <0.001) and hypertension ( P <0.001) and less atrial fibrillation ( P =0.003), smoking ( P =0.003), and education ( P <0.001) than non-Hispanic whites (n=422). Sex, insurance status, high cholesterol, previous stroke/transient ischemic attack history, excessive alcohol use, tPA (tissue-type plasminogen activator) treatment, National Institutes of Health Stroke Scale score, and comorbidity index did not significantly differ by ethnicity. There was no significant difference in medication adherence for any of the 5 drug classes between Mexican Americans and non-Hispanic whites. Conclusions— This study did not find ethnic differences in medication adherence, thus challenging this patient-level factor as an explanation for stroke recurrence disparities. Other reasons for the excessive stroke recurrence burden in Mexican Americans, including provider and health system factors, should be explored.

Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

“…Regarding the choice to study statins in the present study, and not, e.g., antihypertensives or anticoagulants also used in ischemic stroke prevention, were based on previous studies showing no significant differences in adherence or persistence to treatment between statins, anticoagulants, and antihypertensives [ 30 , 31 ]. Further, because the SPDR does not contain data of daily doses, the estimates of adherence from SPDR were possible to perform more precisely in statins that merely are prescribed once per day.…”

Investigation of Medication Adherence and Factors Affecting It in Patients With Stroke

“…Risk of recurrent stroke can be reduced if these medications are used appropriately. 5 It is important to evaluate medication adherence (MA) and barriers to MA in secondary stroke prevention. Therefore, it is necessary to investigate the factors causing medication nonadherence in case of recurrent stroke.…”

Deceptive Adherence to Anticoagulation in Secondary Stroke Prevention

“…The patients who did not start or were not prescribed OAC after stroke occurrence (n = 151) were significantly older (82:5 ± 9:1 years; p < 0:001) and had more severe stroke (median NIHSS [IQR] at discharge 12 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; p < 0:001), 82% died within 1 year following the index stroke. The characteristics of patients who were not prescribed OAC and those who did not purchase the prescription were not significantly different.…”

“…While there have been numerous studies reporting realworld data on OAC use and therapy adherence in AF patients, much less is known about OAC treatment following an ischemic stroke [6][7][8][9][10][11][12][13][14]. These studies on OAC in stroke patients have reported somewhat different results depending on the aim of the study, methods used, and type of patient cohort and/or time of evaluation after stroke.…”