Socioeconomic Status and Nonadherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

Alsabbagh, Mhd Wasem; Lemstra, Mark; Eurich, Dean T.; Lix, Lisa M.; Wilson, Thomas W.; Watson, Erin; Blackburn, David

doi:10.1016/j.jval.2013.11.011

Cited by 70 publications

(64 citation statements)

References 71 publications

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“…Alsabbagh et al showed significant correlation of low adherence in therapy and patients' socio-economic conditions [7]. In our study this information was not described, although co-payment was high enough for medication purchase, which partly could provoke purchase of the prescribed medications.…”

Section: Int Conf Society Health Welfare 2014contrasting

confidence: 48%

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The causes of low adherence in patients with antihypertensive therapy

et al. 2016

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Abstract. Low adherence to antihypertensive therapy is a major cause of adverse cardiovascular outcomes by uncontrolled high blood pressure. If the most frequent causes of inappropriate taking of medicine are identified, possible improvements within the health care could be performed, promoting the safety and efficacy of antihypertensive therapy. The aim was to find the factors affecting patient's adherence during antihypertensive therapy. In the period from June to September 2014 a quantitative study was carried out including patients with diagnosed arterial hypertension who visited pharmacies in Riga to get the antihypertensive therapy. The study collected data of 152 patients with the mean antihypertensive treatment duration of 9.7 ± 2.4 years. Most of the patients knew the reason for the use of the medication (n = 123, 80.8%), but it was also unclear for some patients (n = 29, 19.2%), more frequently with use of 2 or 3 medications at the same time, compared with the patients who received 4 or more medications (n = 26, 17.3% vs n = 3, 1.9%; p = 0.063). High medication load was more frequently associated with lower adherence during antihypertensive therapy. Awareness of antihypertensive therapy for an individual patient, reminders of prescribed medications and dosage instructions may contribute to adherence of patients.

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Section: Int Conf Society Health Welfare 2014contrasting

confidence: 48%

“…Most common doctor related factors include communication skills, knowledge of language and skill of implement royalty. Such health care system associated factors as distance to doctor's praxis and pharmacy, and system of medication compensation also can effect adherence [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

The causes of low adherence in patients with antihypertensive therapy

et al. 2016

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“…The sample characteristic moderator analyses suggested interventions were more effective for older, female, and middle- or upper-income subjects. These findings suggest different interventions need to be developed for men, younger subjects, and adults with limited income [161]. …”

Section: Discussionmentioning

confidence: 99%

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

et al. 2015

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This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

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“…7 Low SEP is one of the predictors of nonadherence to preventive therapies, including statins, although previous research has reported varying results on the strength of this association. 7,8 Several studies, 7,[9][10][11][12] yet not all, 13 have found low income to predict statin nonadherence. Results on the association between education and statin nonadherence are mixed: low education level has been associated with statin nonadherence, 9,10 but higher education has also been found to predict statin nonadherence 9,11,13 or there has been no association.…”

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confidence: 99%

Socioeconomic Inequalities in Statin Adherence Under Universal Coverage

Aarnio

Martikainen

Winn

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Research on the association between SEP and statin adherence has mainly defined adherence through measures that reduce longitudinal medication-taking behavior into a single number, 12,13 such as the proportion of days covered (PDC). 7,9 Although this simplification is appealing, it leads to loss of information on medication-taking patterns over time. Group-based trajectory modeling (GBTM) 15 offers an alternative method for summarizing longitudinal data on medication Background-Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence. We investigated the relationship between SEP and statin adherence in a country with universal coverage using group-based trajectory modeling in addition to the proportion of days covered. Methods and Results-Using data from Finnish healthcare registers, we identified 116 846 individuals, aged 45 to 75 years, who initiated statin therapy for primary prevention of cardiovascular disease. We measured adherence as proportion of days covered over an 18-month period since initiation and identified different adherence patterns based on monthly adherence with group-based trajectory modeling. When adjusted for age, marital status, residential area, clinical characteristics, and copayment, low SEP was associated with statin nonadherence (proportion of days covered <80%) among men (eg, lowest versus highest income quintile: odds ratio, 1.41; 95% confidence interval, 1.32-1.50; basic versus higher-degree education: odds ratio, 1.18; 95% confidence interval, 1.13-1.24; unemployment versus employment: odds ratio, 1.17; 95% confidence interval, 1.10-1.25). Among women, the corresponding associations were different (P<0.001 for sex-byincome quintile, sex-by-education level, and sex-by-labor market status interactions) and mainly nonsignificant. Results based on adherence trajectories showed that men in low SEP were likely to belong to trajectories presenting a fast decline in adherence. Conclusions-Low SEP was associated with overall and rapidly increasing statin nonadherence among men. Conversely, in women, associations between SEP and nonadherence were weak and inconsistent. adherence. GBTM accounts for the dynamic nature of adherence and identifies long-term patterns of the repeatedly measured adherence and groups of individuals with similar patterns. 16,17 Statin adherence trajectories have also been shown to predict cardiovascular events. 18Despite the universal healthcare, socioeconomic disparities in CVD have been documented also in Finland: lower SEP has been associated with higher CVD morbidity and mortality, lower use of statins, and lower revascularization rates. 3,[19][20][21] The aim of our study was to determine the association of SEP with nonadherence and adherence trajectories in Finnish patients initiating statin therapy for primary prevention of CVD. To refine the estimation of the effect of SEP on statin nonadherence, we measured adherence as 18-month adherence trajectories in addition to a conventional dichot...

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Socioeconomic Status and Nonadherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

Cited by 70 publications

References 71 publications

The causes of low adherence in patients with antihypertensive therapy

The causes of low adherence in patients with antihypertensive therapy

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

Socioeconomic Inequalities in Statin Adherence Under Universal Coverage

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