Majercak Kayleigh R, Magder Laurence S, Villalonga-Olives Ester
University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research, 220 Arch Street, 12th Floor, Baltimore, MD 21201, Baltimore, MD, USA.
University of Maryland Baltimore, School of Medicine, Department of Epidemiology and Public Health, 660 W. Redwood Street, Baltimore, MD 21201, Baltimore, MD, USA.
SSM Popul Health. 2020 Oct 5;12:100671. doi: 10.1016/j.ssmph.2020.100671. eCollection 2020 Dec.
Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.
处方药支出和其他财务因素（如自付费用）部分解释了与费用相关的药物治疗不依从性（CRN）的差异。邻里因素和社会支持等社会资本指标可能会影响老年人的健康和福祉，因为他们可能依赖社区资源以及家庭和同伴的支持来管理病情。先前关于社会资本与CRN关系的研究证据有限且结果相互矛盾。因此，我们的目标是采用纵向设计（2006年至2016年），在美国全国代表性的老年人样本中评估社会资本指标（邻里社会凝聚力、邻里物理环境紊乱、积极社会支持和消极社会支持）与CRN之间的关系。健康与退休研究是一项对年龄≥50岁的美国成年人进行的前瞻性面板研究，每两年评估一次。数据汇总形成三个波次，并使用广义估计方程模型进行拟合，同时对基线和随时间变化的协变量（年龄、性别、教育程度、种族、家庭总收入和自我感知健康状况）进行调整。这三个波次分别包括11,791名、12,336名和9,491名参与者。较高水平的邻里社会凝聚力和积极社会支持与较低的CRN相关（比值比[OR]为0.92，95%置信区间[CI]为0.88 - 0.95；OR为0.77，95%CI为0.70 - 0.84，p<0.01）。相反，较高水平的邻里物理环境紊乱和消极社会支持与较高的CRN相关（OR为1.07，95%CI为1.03 - 1.11；OR为1.46，95%CI为1.32 - 1.62，p<0.01）。需要针对社会资本进行干预，加强积极社会支持和邻里社会凝聚力，并减少老年人的邻里物理环境紊乱和消极社会支持。
