LaRosa Anna R, Swabe Gretchen M, Magnani Jared W
Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Int J Cardiol Cardiovasc Risk Prev. 2022 Jun 16;14:200140. doi: 10.1016/j.ijcrp.2022.200140. eCollection 2022 Sep.
To investigate the relation of annual household income to antiplatelet adherence following PCI.
Treatment with 6-12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) is a Class I recommendation. Adherence to these medications is essential to reduce risk of stent thrombosis and recurrent ischemic events. Social risk factors like household income modify how patients access and adhere to essential pharmacologic therapies such as antiplatelet agents.
We identified individuals presenting with PCI in an administrative claims database of commercially insured and Medicare Advantage beneficiaries from 2017 to 2019. We collected data on age, sex, race, ethnicity, educational attainment, and covariates (prevalent coronary disease, medications, healthcare visits, insurance type, copay, antiplatelet medications, and Elixhauser Comorbidity Index conditions). We related annual household income, categorized as <$40,000; $40-49,999; $50-59,999; $60-74,999; $75-99,999; and ≥$100 K, to proportion of days covered (PDC) in multivariable-adjusted regression models. We defined non-adherence as PDC <80%.
Our dataset included 90,163 individuals (age 69.0 ± 10.9 years, 33.1% women, 25.1% non-White race) who underwent PCI. We observed graded, decreased antiplatelet adherence across income categories: rates of PDC≥80% decreased with successively lower income. Individuals with annual income <$40,000 had 1.5-fold higher odds of non-adherence (95% CI, 1.40-1.56) compared to those with income ≥$100,000 after multivariable adjustment.
In a claims-based analysis, we determined that lower income is associated with decreased likelihood of adherence to antiplatelet agents following PCI. Our results indicate the importance of considering social risk factors in the evaluation of barriers to antiplatelet adherence following PCI.
探讨PCI术后家庭年收入与抗血小板治疗依从性之间的关系。
经皮冠状动脉介入治疗（PCI）后进行6至12个月的双联抗血小板治疗（DAPT）是I类推荐。坚持服用这些药物对于降低支架血栓形成风险和复发性缺血事件至关重要。家庭收入等社会风险因素会影响患者获取和坚持使用抗血小板药物等基本药物治疗的方式。
我们在一个涵盖2017年至2019年商业保险和医疗保险优势受益人的行政索赔数据库中，识别出接受PCI治疗的个体。我们收集了年龄、性别、种族、民族、教育程度以及协变量（冠心病患病率、药物治疗、医疗就诊、保险类型、自付费用、抗血小板药物以及埃利克斯豪泽合并症指数情况）的数据。我们将家庭年收入分为<$40,000、$40 - 49,999、$50 - 59,999、$60 - 74,999、$75 - 99,999和≥$100,000，并在多变量调整回归模型中将其与覆盖天数比例（PDC）相关联。我们将依从性差定义为PDC<80%。
我们的数据集包括90163名接受PCI治疗的个体（年龄69.0±10.9岁，女性占33.1%，非白人种族占25.1%）。我们观察到不同收入类别中抗血小板治疗依从性呈梯度下降：PDC≥80%的比例随着收入的降低而依次下降。多变量调整后，年收入<$40,000的个体与收入≥$100,000的个体相比，依从性差的几率高1.5倍（95%CI，1.40 - 1.56）。
在基于索赔的分析中，我们确定低收入与PCI术后抗血小板药物治疗依从性降低相关。我们的结果表明，在评估PCI术后抗血小板治疗依从性障碍时，考虑社会风险因素的重要性。
