家庭收入与心力衰竭患者使用沙库巴曲缬沙坦的机会和依从性的关系：一项商业保险患者的回顾性分析。
Relation of Household Income to Access and Adherence to Combination Sacubitril/Valsartan in Heart Failure: A Retrospective Analysis of Commercially Insured Patients.
机构信息
Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh, PA (A.E.J., J.W.M.).
Division of Cardiology, University of Pittsburgh School of Medicine (A.E.J., G.M.S., J.W.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2022 Jul;15(7):e009179. doi: 10.1161/CIRCOUTCOMES.122.009179. Epub 2022 May 13.
BACKGROUND
Outcomes in heart failure with reduced ejection fraction (HFrEF) are influenced by access and adherence to guideline-directed medical therapy. Our objective was to study the association between annual household income and: (1) the odds of having a claim for sacubitril/valsartan among insured patients with HFrEF and (2) medication adherence (measured as the proportion of days covered). We hypothesized that lower annual household income is associated with decreased odds of having a claim for and adhering to sacubitril/valsartan.
METHODS
Using the Optum de-identified Clinformatics Data Mart, patients with HFrEF and ≥6 months of enrollment for follow-up (2016-2020) were included. Covariates included age, sex, race, ethnicity, educational attainment, US region, number of prescribed medications, and Elixhauser Comorbidity Index. Prescription for sacubitril/valsartan was defined by the presence of a claim within 6 months of HFrEF diagnosis. Adherence was defined as proportion of days covered ≥80%. We fit multivariable-adjusted logistic regression models and hierarchical logistic regression accounting for covariates.
RESULTS
Among 322 007 individuals with incident HFrEF, 135 282 had complete data for analysis. Of the patients eligible for sacubitril/valsartan, 4.7% (6372) had a claim within 6 months of HFrEF diagnosis. Following multivariable adjustment, individuals in the lowest annual income category (<$40 000) were significantly less likely (odds ratio, 0.83 [95% CI, 0.76-0.90]) to have a sacubitril/valsartan claim within 6 months of HFrEF diagnosis than those in the highest annual income category (≥$100 000). Annual income <$40 000 was associated with lower odds of proportion of days covered ≥80% compared with income ≥$100 000 (odds ratio, 0.70 [95% CI, 0.59-0.83]).
CONCLUSIONS
Lower household income is associated with decreased likelihood of a sacubitril/valsartan claim and medication adherence within 6 months of HFrEF diagnosis, even after adjusting for sociodemographic and clinical factors. Future analyses are needed to identify additional social factors associated with delays in sacubitril/valsartan initiation and long-term adherence.
背景
射血分数降低的心力衰竭（HFrEF）患者的预后受到是否能获得并遵医嘱使用指南推荐的药物治疗的影响。我们的研究目的是分析年度家庭收入与以下两者之间的相关性：（1）在投保的 HFrEF 患者中，年度家庭收入与使用沙库巴曲缬沙坦的可能性之间的关系；（2）药物的依从性（以覆盖率来衡量）。我们假设，较低的年度家庭收入与使用沙库巴曲缬沙坦的可能性较低和药物依从性较差有关。
方法
利用 Optum 去识别 Clinformatics 数据集市，纳入了 2016 年至 2020 年期间有 HFrEF 且至少 6 个月随访的患者。协变量包括年龄、性别、种族、民族、教育程度、美国地区、处方药物数量和 Elixhauser 合并症指数。沙库巴曲缬沙坦的处方定义为在 HFrEF 诊断后 6 个月内有用药记录。药物依从性定义为覆盖率≥80%。我们采用多变量调整的逻辑回归模型和分层逻辑回归模型来分析这些数据。
结果
在 322007 例新发 HFrEF 患者中，有 135282 例患者的数据完整，可用于分析。在有资格使用沙库巴曲缬沙坦的患者中，有 4.7%（6372 例）在 HFrEF 诊断后 6 个月内有用药记录。经多变量调整后，收入最低的类别（<$40000）的患者在 HFrEF 诊断后 6 个月内使用沙库巴曲缬沙坦的可能性明显较低（比值比，0.83[95%置信区间，0.76-0.90]），而收入最高的类别（≥$100000）的患者则更高。与收入≥$100000 的患者相比，收入<$40000 的患者的覆盖率≥80%的可能性较低（比值比，0.70[95%置信区间，0.59-0.83]）。
结论
即使在调整了社会人口统计学和临床因素后，较低的家庭收入也与 HFrEF 诊断后沙库巴曲缬沙坦的使用和药物依从性降低有关。需要进一步的分析来确定与沙库巴曲缬沙坦的起始延迟和长期依从性相关的其他社会因素。
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