Department of Emergency Medicine (M.E.W., M.L.M.), The George Washington University, Medical Faculty Associates, Washington, DC.
Department of Health Policy and Management (Z.Z., Y.L., M.L.M.), The George Washington University, Washington, DC.
Circ Cardiovasc Qual Outcomes. 2022 Feb;15(2):e008150. doi: 10.1161/CIRCOUTCOMES.121.008150. Epub 2022 Jan 31.
Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension.
We conducted a posthoc subgroup analysis of 3044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of hypertension based on their Medicaid claims during a 24-month period before study enrollment. We calculated the proportion of days covered by at least one antihypertensive medication during the first 12 months after study enrollment using the prescription claims data. We measured numerous SDH at the time of study enrollment and we categorized our hypertension cohort into 4 social risk groups based on their response profiles to the SDH variables. We compared the mean proportion of days covered by the different levels of the SDH factors. We modeled the odds of being covered by an antihypertensive medication daily throughout the follow-up period by social risk group, adjusted for age, sex, and disease severity using a generalized linear model.
The nonrandom sample was predominately Black (93%), female (62%) and had completed high school (77%). The mean proportion of days covered varied significantly by different SDH, such as food insecurity (49%-56%), length of time living at present place (47%-57%), smoking status (50%-56%), etc. Social risk group was a significant predictor of medication adherence. Participants in the 2 groups with the most social risks were 36% (adjusted odds ratio=0.64 [95% CI, 0.53-0.78]) and 20% (adjusted odds ratio=0.80 [95% CI, 0.70-0.93]) less adherent to their hypertension therapy compared with participants in the group with the fewest social risks.
Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.
关于社会决定因素（SDH）与医疗补助计划（Medicaid）受益的高血压患者药物依从性之间的关系，知之甚少。
我们对参加一项前瞻性队列研究的 3044 名成年 Medicaid 受益人的亚组进行了事后分析，这些人在研究入组前的 24 个月内根据他们的 Medicaid 理赔记录被诊断为高血压。我们使用处方理赔数据计算了研究入组后第 12 个月内至少有一种抗高血压药物的天数覆盖率。在研究入组时，我们测量了大量的 SDH，并根据他们对 SDH 变量的反应特征将我们的高血压队列分为 4 个社会风险组。我们比较了不同 SDH 因素水平的平均天数覆盖率。我们使用广义线性模型，根据年龄、性别和疾病严重程度，对社会风险组在整个随访期间每天服用抗高血压药物的可能性进行了建模。
这个非随机样本主要是黑人（93%），女性（62%），并完成了高中学业（77%）。不同 SDH 的平均天数覆盖率差异显著，如食物无保障（49%-56%）、目前居住时间长短（47%-57%）、吸烟状况（50%-56%）等。社会风险组是药物依从性的重要预测因素。具有最多社会风险的 2 个组的参与者的依从性分别降低了 36%（调整后的优势比=0.64[95%CI，0.53-0.78]）和 20%（调整后的优势比=0.80[95%CI，0.70-0.93]），与具有最少社会风险的组相比。
社会风险与 Medicaid 人群中抗高血压药物的依从性降低有关。
