Agapito Ivann, Hoang Tu, Sayer Michael, Naqvi Ali, Patel Pranav M, Ozaki Aya F
School of Pharmacy & Pharmaceutical Sciences, Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, CA 92697, United States.
Division of Cardiology, Department of Medicine, University of California Irvine, Irvine, CA 92697, United States.
J Am Med Inform Assoc. 2024 Dec 1;31(12):2924-2931. doi: 10.1093/jamia/ocae203.
Identifying sources of sex-based disparities is the first step in improving clinical outcomes for female patients. Using All of Us data, we examined the association of biological sex with cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities.
Retrospective data collection identified the following patients: 18 and older, completing personal medical history surveys, having hypertension (HTN), ischemic heart disease (IHD), or heart failure (HF) with medication use history consistent with these diagnoses. Implementing univariable and adjusted logistic regression, we assessed the influence of biological sex on 7 different patient-reported CRMA outcomes within HTN, IHD, and HF patients.
Our study created cohorts of HTN (n = 3891), IHD (n = 5373), and HF (n = 2151) patients having CRMA outcomes data. Within each cohort, females were significantly more likely to report various cost-related medication issues: being unable to afford medications (HTN hazards ratio [HR]: 1.68, confidence interval [CI]: 1.33-2.13; IHD HR: 2.33, CI: 1.72-3.16; HF HR: 1.82, CI: 1.22-2.71), skipping doses (HTN HR: 1.76, CI: 1.30-2.39; IHD HR: 2.37, CI: 1.69-3.64; HF HR: 3.15, CI: 1.87-5.31), taking less medication (HTN HR: 1.86, CI: 1.37-2.45; IHD HR: 2.22, CI: 1.53-3.22; HF HR: 2.99, CI: 1.78-5.02), delaying filling prescriptions (HTN HR: 1.83, CI: 1.43-2.39; IHD HR: 2.02, CI: 1.48-2.77; HF HR: 2.99, CI: 1.79-5.03), and asking for lower cost medications (HTN HR: 1.41, CI: 1.16-1.72; IHD HR: 1.75, CI: 1.37-2.22; HF HR: 1.61, CI: 1.14-2.27).
Our results clearly demonstrate CRMA issues disproportionately affect female patients with cardiovascular comorbidities, which may contribute to the larger sex-based disparities in cardiovascular care. These findings call for targeted interventions and strategies to address these disparities and ensure equitable access to cardiovascular medications and care for all patients.
识别基于性别的差异来源是改善女性患者临床结局的第一步。利用“我们所有人”项目的数据，我们研究了生物性别与患有心血管合并症患者的与费用相关的用药依从性（CRMA）问题之间的关联。
回顾性数据收集确定了以下患者：年龄在18岁及以上，完成个人病史调查，患有高血压（HTN）、缺血性心脏病（IHD）或心力衰竭（HF）且用药史与这些诊断相符。通过实施单变量和校正逻辑回归，我们评估了生物性别对HTN、IHD和HF患者中7种不同的患者报告的CRMA结局的影响。
我们的研究创建了具有CRMA结局数据的HTN患者队列（n = 3891）、IHD患者队列（n = 5373）和HF患者队列（n = 2151）。在每个队列中，女性更有可能报告各种与费用相关的用药问题：无力支付药物费用（HTN风险比[HR]：1.68，置信区间[CI]：1.33 - 2.13；IHD HR：2.33，CI：1.72 - 3.16；HF HR：1.82，CI：1.22 - 2.71）、漏服剂量（HTN HR：1.76，CI：1.30 - 2.39；IHD HR：2.37，CI：1.69 - 3.64；HF HR：3.15，CI：1.87 - 5.31）、减少用药量（HTN HR：1.86，CI：1.37 - 2.45；IHD HR：2.22，CI：1.53 - 3.22；HF HR：2.99，CI：1.78 - 5.02）、延迟配药（HTN HR：1.83，CI：1.43 - 2.39；IHD HR：2.02，CI：1.48 - 2.77；HF HR：2.99，CI：1.79 - 5.03）以及要求使用低成本药物（HTN HR：1.41，CI：1.16 - 1.72；IHD HR：1.75，CI：1.37 - 2.22；HF HR：1.61，CI：1.14 - 2.27）。
我们的结果清楚地表明，CRMA问题对患有心血管合并症的女性患者影响更大，这可能导致心血管护理中基于性别的更大差异。这些发现呼吁采取有针对性的干预措施和策略来解决这些差异，并确保所有患者都能公平获得心血管药物和护理。
