Assistant Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL., Email:
Scientist III, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
Am J Health Behav. 2020 Mar 1;44(2):232-243. doi: 10.5993/AJHB.44.2.10.
Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.
已有研究记录了患者不遵医嘱的情况，但尚未研究社会风险因素对用药不依从的综合影响。我们对基于人群的前瞻性队列研究——冠状动脉风险发展在年轻人（CARDIA）研究的数据进行了横断面分析。该样本（N=1506）包括在第 20 年（2005-06 年）正在服用处方药并完成了 4 项用药依从性量表的受试者。社会风险因素包括高中或以下学历、家庭年收入<25000 美元、经济压力大、慢性压力大、社会支持度低和社会压力大。在完全调整的逻辑回归模型中，收入<25000 美元（OR=2.37[95%CI 1.12-4.98]，p<0.05）和慢性压力大（OR=2.07[95%CI 1.09-3.94]，p<0.05）与用药不依从显著相关。具有≥3 个社会风险因素的个体比没有社会风险因素的个体不依从的可能性高 3 倍以上（OR=3.26[95%CI 1.72-6.19]，p<0.001）。低收入和慢性压力与用药不依从有关，随着社会风险因素的积累，不依从的可能性会增加。这些发现可用于开发风险预测工具，以识别可以从增强依从性干预中受益的个体。
