J Am Pharm Assoc (2003). 2021 Jul-Aug;61(4):e263-e278. doi: 10.1016/j.japh.2021.01.032. Epub 2021 Feb 23.
Latino adults, especially immigrants without citizenship (i.e., noncitizens), experience considerable barriers to health care, including medications. Inequitable access to medications, especially statins, may exacerbate disparities in cardiovascular disease. Despite this, little is known about medication nonadherence in Latino neighborhoods, especially those with large noncitizen populations.
To estimate nonadherence to statins in Latino neighborhoods and evaluate differences on the basis of their noncitizen population.
We conducted a retrospective cohort study among 48,161 adults who lived in predominately Latino neighborhoods in New York City, Los Angeles, and Chicago and who initiated statin therapy from January 2012 to December 2015 using IQVIA LifeLink. Statin nonadherence was defined as a proportion of days covered amounting to less than 80% over 12 months. We focused on differences between neighborhoods with high noncitizen concentrations (areas where noncitizens are at least 35% of the adult population) and other Latino neighborhoods. We examined associations using logistic regressions adjusted for individual (e.g., payment method) and neighborhood characteristics (e.g., poverty).
Individuals living in neighborhoods with high noncitizen concentrations were more nonadherent to statins than those in Latino neighborhoods with fewer noncitizens (75.0% vs. 70.0%, adjusted odds ratio [aOR] 1.18, [95% CI 1.06-1.33]). These disparities were worse in New York City (77.7% vs. 69.1%, aOR 1.37, [95% CI 1.23-1.53]) and Chicago (76.1% vs. 68.8%, aOR 1.38, [95% CI 1.14-1.67]) than in Los Angeles (73.8% vs. 71.3%, aOR 1.10, [95% CI 1.01-1.20]).
Neighborhoods with large noncitizen populations have much higher rates of statin nonadherence than Latino neighborhoods with fewer noncitizens. These disparities were least pronounced in Los Angeles, where the county provides health care to all uninsured residents, including noncitizens without documentation to reside in the United States. Efforts to improve medication access in Latino neighborhoods should be multifocal and start by implementing state and local health care options for low-income residents, regardless of citizenship status.
拉丁裔成年人，尤其是没有公民身份的移民（即非公民），在获得医疗保健方面面临着相当大的障碍，包括药物治疗。药物获取的不平等，特别是他汀类药物的获取不平等，可能会加剧心血管疾病方面的差异。尽管如此，对于拉丁裔社区的药物不依从性，特别是那些拥有大量非公民人口的社区，人们知之甚少。
评估拉丁裔社区中他汀类药物的不依从性，并根据其非公民人口数量进行评估。
我们对 2012 年 1 月至 2015 年 12 月期间在纽约市、洛杉矶和芝加哥主要为拉丁裔人群居住的地区使用 IQVIA LifeLink 开始使用他汀类药物治疗的 48161 名成年人进行了回顾性队列研究。他汀类药物不依从性定义为在 12 个月内覆盖率比例低于 80%。我们重点关注非公民浓度高的社区（非公民占成年人口至少 35%的地区）和其他拉丁裔社区之间的差异。我们使用调整了个体（如付款方式）和社区特征（如贫困）的逻辑回归检查了关联。
与非公民较少的拉丁裔社区相比，生活在非公民浓度高的社区中的个体服用他汀类药物的不依从性更高（75.0%比 70.0%，调整后的优势比[OR]1.18，[95%置信区间[CI]1.06-1.33]）。在纽约市（77.7%比 69.1%，调整后的 OR 1.37，[95%CI 1.23-1.53]）和芝加哥（76.1%比 68.8%，调整后的 OR 1.38，[95%CI 1.14-1.67]），这些差异比在洛杉矶（73.8%比 71.3%，调整后的 OR 1.10，[95%CI 1.01-1.20]）更明显。
非公民人口较多的社区中，他汀类药物的不依从率远高于非公民人口较少的拉丁裔社区。在洛杉矶，这些差异最小，该县为所有无保险居民提供医疗保健，包括没有在美国居住证明的非公民。改善拉丁裔社区药物获取的努力应该是多方面的，首先要为低收入居民实施州和地方医疗保健选择，无论其公民身份如何。
