Guerra Carlos, Conte Eric, Del Rio Angela Isabel, Motta Jorge, Moreno Velásquez Ilais, Quintana Hedley Knewjen
Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City 0816-02593, Panama.
Ministry of Health, Panama City 0843-03441, Panama.
Healthcare (Basel). 2022 Nov 9;10(11):2244. doi: 10.3390/healthcare10112244.
Poor medication adherence is a public health concern leading to a large burden of cardiovascular disease among persons with hypertension. Using data from 3281 persons with diagnosed hypertension (N = 622,581) from the Panamanian National Health Survey (ENSPA) collected in 2019, we assessed the national prevalence of low-moderate medication adherence in hypertensive individuals using the 4-scale Morisky Medication Adherence Scale (4-MMAS) and identifying gender-specific associated factors. Multivariate logistic regression models were used to estimate the association between possible risk factors and low-moderate medication adherence with odds ratios (OR) and 95% confidence intervals (95% CI) stratified by gender. The national prevalence of low-moderate medication adherence was 78.2% (95% CI: 74.7-81.0%); in men it was 74.4% (95% CI: 67.5-80.3%) and in women it was 81.4% (78.4-84.0%). In women, low-moderate medication adherence was associated with living in indigenous area (OR: 5.15; 95% CI: 1.40-18.98), educational level (OR no formal education: 0.77, 95% CI 0.28-2.14; OR for primary education: 0.76, 95% CI 0.38-1.56; OR for secondary education: 0.90, 95% CI 0.48-1.70; Higher education as reference), increased BMI (normal as reference, OR for overweight: 1.35, 95% CI: 0.73-2.50, OR for obesity: 1.65, 95% CI: 0.90-3.03) and medical diagnosis of anxiety/depression (OR: 4.89, 95% CI: 1.36-17.49). However, in men, it was associated with having secondary education (OR: 2.94; 95% CI: 1.03-8.36), currently smoking (OR: 16.74, 95% CI: 1.83-152.70), taking antihypertensive medication with denial of hypertension diagnosis (OR: 4.35, 95% CI: 1.11-17.11) and having less than three annual check-ups (OR for no health check-ups: 2.97, 95% CI: 0.63-13.88; OR for 1-2 check-ups: 1.61, 95% CI: 0.78-3.32: three or more health check-ups: reference). Time since diagnosis was inversely associated with low-moderate adherence. This study assesses for the first time the national prevalence of low-moderate medication adherence among hypertensive individuals in Panama. Low-moderate medication adherence is an important public health issue that should be addressed to achieve blood pressure control in patients diagnosed with hypertension, taking into account gender-specific factors.
用药依从性差是一个公共卫生问题，会给高血压患者带来巨大的心血管疾病负担。利用2019年巴拿马全国健康调查（ENSPA）中3281例确诊高血压患者（N = 622,581）的数据，我们使用4级Morisky用药依从性量表（4-MMAS）评估了高血压患者中低-中度用药依从性的全国患病率，并确定了特定性别的相关因素。采用多变量逻辑回归模型，以比值比（OR）和按性别分层的95%置信区间（95%CI）估计可能的风险因素与低-中度用药依从性之间的关联。低-中度用药依从性的全国患病率为78.2%（95%CI：74.7-81.0%）；男性为74.4%（95%CI：67.5-80.3%），女性为81.4%（78.4-84.0%）。在女性中，低-中度用药依从性与居住在原住民地区（OR：5.15；95%CI：1.40-18.98）、教育水平（OR无正规教育：0.77，95%CI 0.28-2.14；小学教育OR：0.76，95%CI 0.38-1.56；中学教育OR：0.90，95%CI 0.48-1.70；以高等教育为参照）、BMI增加（以正常为参照，超重OR：1.35，95%CI：0.73-2.50，肥胖OR：1.65，95%CI：0.90-3.03）以及焦虑/抑郁的医学诊断（OR：4.89，95%CI：1.36-17.49）相关。然而，在男性中，它与接受中学教育（OR：2.94；95%CI：1.03-8.36）、当前吸烟（OR：16.74，95%CI：1.83-152.70）、服用抗高血压药物但否认高血压诊断（OR：4.35，95%CI：1.11-17.11）以及每年体检少于三次（无健康检查OR：2.97，95%CI：0.63-13.88；1-2次检查OR：1.61，95%CI：0.78-3.32：三次或更多次健康检查为参照）相关。自诊断以来的时间与低-中度依从性呈负相关。本研究首次评估了巴拿马高血压患者中低-中度用药依从性的全国患病率。低-中度用药依从性是一个重要的公共卫生问题，在实现高血压患者血压控制时应予以解决，同时要考虑到特定性别的因素。
