Gerber Ben S, Cho Young Ik, Arozullah Ahsan M, Lee Shoou-Yih D
Center for Management of Complex Chronic Care, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA.
Am J Geriatr Pharmacother. 2010 Apr;8(2):136-45. doi: 10.1016/j.amjopharm.2010.03.002.
Racial differences in adherence to prescribed medication regimens have been reported among the elderly. It remains unclear, however, whether these differences persist after controlling for confounding variables.
The objective of this study was to determine whether racial differences in medication adherence between African American and white seniors persist after adjusting for demographic characteristics, health literacy, depression, and social support. We hypothesized that differences in adherence between the 2 races would be eliminated after adjusting for confounding variables.
A survey on medication adherence was conducted using face-to-face interviews with Medicare recipients >or=65 years of age living in Chicago. Participants had to have good hearing and vision and be able to speak English to enable them to respond to questions in the survey and sign the informed-consent form. Medication adherence measures included questions about: (1) running out of medications before refilling the prescriptions; (2) following physician instructions on how to take medications; and (3) forgetting to take medications. Individual crude odds ratios (CORs) were calculated for the association between race and medication adherence. Adjusted odds ratios (AORs) were calculated using the following covariates in multivariate logistic regression analyses: race; age; sex; living with a spouse, partner, or significant other; income; Medicaid benefits; prescription drug coverage; having a primary care physician; history of hypertension or diabetes; health status; health literacy; depression; and social support.
Six hundred thirty-three eligible cases were identified. Of the 489 patients who responded to the survey, 450 (266 African American [59%; mean age, 78.2 years] and 184 white [41%; mean age, 76.8 years]; predominantly women) were included in the sample. The overall response rate for the survey was 77.3%. African Americans were more likely than whites to report running out of medications before refilling them (COR = 3.01; 95% CI, 1.72-5.28) and not always following physician instructions on how to take medications (COR = 2.64; 95% CI, 1.50-4.64). However, no significant difference between the races was observed in forgetting to take medications (COR = 0.90; 95% CI, 0.61-1.31). In adjusted analyses, race was no longer associated with low adherence due to refilling (AOR = 1.60; 95% CI, 0.74-3.42). However, race remained associated with not following physician instructions on how to take medications after adjusting for confounding variables (AOR = 2.49; 95% CI, 1.07-5.80).
Elderly African Americans reported that they followed physician instructions on how to take medications less frequently than did elderly whites, even after adjusting for differences in demographic characteristics, health literacy, depression, and social support.
已有报道称老年人在遵医嘱服药方面存在种族差异。然而，在控制混杂变量后这些差异是否依然存在尚不清楚。
本研究的目的是确定在调整人口统计学特征、健康素养、抑郁和社会支持因素后，非裔美国老年人与白人老年人在药物依从性方面的种族差异是否仍然存在。我们假设在调整混杂变量后，两个种族在依从性方面的差异将消除。
采用面对面访谈的方式，对居住在芝加哥年龄≥65岁的医疗保险受益人群进行了一项关于药物依从性的调查。参与者必须听力和视力良好，并且能够说英语，以便能够回答调查问卷中的问题并签署知情同意书。药物依从性测量包括以下问题：（1）在重新开药前用完药物；（2）遵循医生关于如何服药的指示；（3）忘记服药。计算种族与药物依从性之间关联的个体粗比值比（COR）。在多因素逻辑回归分析中，使用以下协变量计算调整后的比值比（AOR）：种族、年龄、性别、与配偶、伴侣或重要他人同住、收入、医疗补助福利、处方药保险、有初级保健医生、高血压或糖尿病病史、健康状况、健康素养、抑郁和社会支持。
共确定了633例符合条件的病例。在489名回复调查的患者中，450名（266名非裔美国人[59%；平均年龄78.2岁]和184名白人[41%；平均年龄76.8岁]；主要为女性）被纳入样本。调查的总体回复率为77.3%。非裔美国人比白人更有可能报告在重新开药前用完药物（COR = 3.01；95%CI，1.72 - 5.28），并且并非总是遵循医生关于如何服药的指示（COR = 2.64；95%CI，1.50 - 4.64）。然而，在忘记服药方面，两个种族之间未观察到显著差异（COR = 0.90；95%CI，0.61 - 1.31）。在调整分析中，种族与因重新开药导致的低依从性不再相关（AOR = 1.60；95%CI，0.74 - 3.42）。然而，在调整混杂变量后，种族与不遵循医生关于如何服药的指示仍然相关（AOR = 2.49；95%CI，1.07 - 5.80）。
老年非裔美国人报告称，即使在调整了人口统计学特征、健康素养、抑郁和社会支持方面的差异后，他们遵循医生关于如何服药指示的频率仍低于老年白人。
