The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis

Wilder, Marceé E.; Kulie, Paige; Jensen, Caroline; Levett, Paul; Blanchard, Janice; Dominguez, Luis W.; Portela, Maria; Srivastava, Aneil; Li, Yixuan; McCarthy, Melissa L.

doi:10.1007/s11606-020-06447-0

Cited by 122 publications

(72 citation statements)

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“…The second hypothesis of geographic clustering of high rates of non-adherence to biguanide medication was also confirmed. A recent systematic review and meta-analysis of 29 studies reported that social determinants of health were associated with medication adherence, but only six of these specifically involved samples of T2DM patients ( Wilder et al, 2021 ). Comparisons of these studies can be difficult due to the different measurement of medication adherence (self-report measures vs measures based on pharmacy dispensing data) and the different social-contextual factors examined.…”

Section: Discussionmentioning

confidence: 99%

“…Social influences and environmental context and resources are key domains in this theoretical framework. In the medication adherence literature to date however, research into these domains remains largely focused on patients and health provider level factors in healthcare settings, with less attention being paid to broader social and contextual determinants of health ( Wilder et al, 2021 ). This circumstance is perpetuated despite past clinical research acknowledging that a failure to consider factors relevant to patients, such as low health literacy, nutritional deprivation, and inability to afford medications, may constitute a ‘contextual error’ resulting in poorer health outcomes ( Weiner et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

“…Another study of an urban adult Medicaid population with T2DM found, however, that distance to dispensing pharmacies and prescribers was not associated with adherence to angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) ( Syed et al, 2016 ). A recent systematic review and metanalysis concluded that adverse social-contextual factors, including housing instability, food insecurity and social determinants overall, can adversely impact medication adherence, however, the review highlighted the limited number of research studies examining social determinants of medication adherence ( Wilder et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Learnihan

Schroers

Coote

et al. 2022

SSM - Population Health

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Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Learnihan

Schroers

Coote

et al. 2022

SSM - Population Health

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“…While this paper provides evidence about complexity of the provider team, several other factors may influence adherence to chronic medications including other provider characteristics (e.g., communication, reimbursement arrangements), social determinants of health, the financial burden of cancer treatment, and physiological responses to cancer and its treatments. Social determinants of health are the conditions in the environments where people live (e.g., transportation, stable housing) and have been linked to medication adherence [ 42 ]. The financial toxicity of cancer treatment is a known constraint for many patients [ 43 , 44 ], which may translate beyond cancer into the management of comorbid chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Providers’ mediating role for medication adherence among cancer survivors

et al. 2021

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Background We conducted a mediation analysis of the provider team’s role in changes to chronic condition medication adherence among cancer survivors. Methods We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We included beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for non-insulin anti-diabetics, statins, and/or anti-hypertensives and similar individuals without cancer from Surveillance, Epidemiology, and End Results-Medicare data, 2008–2014. Chronic condition medication adherence was defined as a proportion of days covered ≥ 80%. Provider team structure was measured using two factors capturing the number of providers seen and the historical amount of patient sharing among providers. Linear regressions relying on within-survivor variation were run separately for each cancer site, chronic condition, and follow-up period. Results The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. Provider team effects were statistically insignificant in 13 of 17 analytic samples with significant changes in adherence. Statistically significant provider team effects were small in magnitude (<0.5 percentage points). Conclusions Increased complexity in the provider team associated with cancer diagnosis did not lead to meaningful reductions in medication adherence. Interventions aimed at improving chronic condition medication adherence should be targeted based on the type of cancer and chronic condition and focus on other provider, systemic, or patient factors.

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“…Next, the compensatory actions needed to avoid or mitigate the effects of food insecurity can push individuals towards behaviors that make it hard to achieve or maintain health. For example, food insecurity is often associated with trade-offs that can worsen health, such as needing to forego medications in order to purchase food [ 6 , 7 ]. This can further sap one’s capacity for self-management as attention is diverted to deal with other pressing matters.…”

Section: Introductionmentioning

confidence: 99%

Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research

et al. 2021

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Purpose of Review To understand recent literature that examines associations between food insecurity and cardiometabolic conditions and risk factors. We included original research, systematic reviews, and meta-analyses on the topic of food insecurity and cardiometabolic risk published from January 1, 2017, to December 31, 2020. Editorials, perspectives, and case reports were excluded. After the initial search, 3 reviewers selected studies for inclusion based on relevance and methods. Ultimately, fifty studies were included. Recent Findings We included 35 studies of adults (20 cross-sectional observational studies, 5 longitudinal observational studies, 5 interventional studies, and 5 meta-analyses/reviews). In adults, food insecurity is associated with greater prevalence of overweight/obesity (especially for women). It is also associated with hypertension, diabetes (including worse glycemic control and more diabetes complications), coronary heart disease, congestive heart failure, stroke, and chronic kidney disease. We included 15 studies of children (11 cross-sectional observational studies and 4 longitudinal observational studies). In children, findings were more nuanced, and in particular, many studies did not find an association between food insecurity and overweight/obesity. However, authors noted that these conditions may not have had time to develop. With notable exceptions, many studies were cross-sectional, and there were few interventions. Summary There is a robust association between food insecurity and cardiometabolic conditions and risk factors in adults, but the picture is less clear in children. Overt cardiometabolic clinical conditions develop more rarely in children, but childhood experiences may set a trajectory for worse health later in life. Detailed life course epidemiologic studies are needed to better understand this relationship. Future interventions should examine how to reduce the prevalence of food insecurity, and how best to improve health for those who experience food insecurity.

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The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis

Cited by 122 publications

References 50 publications

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Providers’ mediating role for medication adherence among cancer survivors

Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research

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