Kilkenny Monique F, Dalli Lachlan L, Andrew Nadine E, Ung David, Kim Joosup, Sundararajan Vijaya, Cadilhac Dominique A, Thrift Amanda G, Nelson Mark R, Olaiya Muideen T
School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia.
Neuroepidemiology. 2025 Jan 8:1-6. doi: 10.1159/000543317.
Cultural and language barriers may affect quality of care, such as adherence to medications. We examined whether adherence to prevention medications within the year after stroke/transient ischemic attack (TIA) differed by the region of birth.
An observational study of adults with stroke/TIA admitted to hospitals in the Australian Stroke Clinical Registry (Queensland, Victoria; 2012-2016; n = 45 hospitals). Data from the registry were linked with administrative data. Region of birth was categorized into 10 groups (Australia, Other Oceania, North-West Europe, Southern/Eastern Europe, North Africa/Middle East, South-East Asia, North-East Asia, Southern/Central Asia, Americas, Sub-Saharan Africa). Analysis was limited to those with a first-ever stroke/TIA who were dispensed an antihypertensive, lipid-lowering, or antithrombotic medication within 1-year post-discharge. Medication adherence was calculated based on the proportion of days covered until 1-year immediately post-discharge/death. Associations between region of birth and being adherent (PDC ≥80%) were determined using multivariable logistic regression (adjusted for age, sex, stroke type, ability to walk on admission, discharge destination, socioeconomic position, main language spoken, comorbidity score).
Among 24,236 eligible participants (median age 74 years, 44% female, 68% Australian-born), 54% were adherent to antihypertensive medications, 56% to lipid-lowering medications, and 49% to antithrombotic medications. Compared to Australian-born participants, those born in Other Oceania (4.0%) were less likely to be adherent to lipid-lowering medications (odds ratio [OR] 0.78, 95% CI: 0.67-0.90) and antithrombotic (OR 0.84, 95% CI: 0.72-0.97). Compared to Australian-born participants, those born in Southern and Central Asia (1.4%) were less likely to be adherent to lipid-lowering medications (OR: 0.76, 95% CI: 0.58-0.99) and antithrombotic (0.55, 95% CI: 0.40-0.76). No significant differences were found with other regions.
Disparities by the region of birth were observed in medication adherence after stroke/TIA for participants born in Asia and Oceania. Targeted education to improve medication adherence, specific to the needs of these groups, is warranted.
文化和语言障碍可能会影响医疗服务质量，比如药物依从性。我们研究了卒中/短暂性脑缺血发作（TIA）后一年内预防用药的依从性是否因出生地区而异。
对澳大利亚卒中临床登记处（昆士兰、维多利亚；2012 - 2016年；45家医院）收治的卒中/TIA成年患者进行一项观察性研究。登记处的数据与行政数据相链接。出生地区分为10组（澳大利亚、其他大洋洲地区、西北欧、南欧/东欧、北非/中东、东南亚、东北亚、南亚/中亚、美洲、撒哈拉以南非洲）。分析仅限于首次发生卒中/TIA且在出院后1年内接受了抗高血压药、降脂药或抗血栓药治疗的患者。药物依从性根据出院后/死亡后即刻1年内的覆盖天数比例来计算。使用多变量逻辑回归（对年龄、性别、卒中类型、入院时行走能力、出院目的地、社会经济地位、主要语言、合并症评分进行校正）来确定出生地区与依从性（药物覆盖天数比例≥80%）之间的关联。
在24236名符合条件的参与者中（中位年龄74岁，44%为女性，68%出生于澳大利亚），54%的人坚持服用抗高血压药物，56%的人坚持服用降脂药物，49%的人坚持服用抗血栓药物。与出生在澳大利亚的参与者相比，出生在其他大洋洲地区的参与者（4.0%）服用降脂药物的依从性较低（比值比[OR]0.78，95%置信区间：0.67 - 0.90），服用抗血栓药物的依从性也较低（OR 0.84，95%置信区间：0.72 - 0.97）。与出生在澳大利亚的参与者相比，出生在南亚和中亚的参与者（1.4%）服用降脂药物的依从性较低（OR：0.76，95%置信区间：0.58 - 0.99），服用抗血栓药物的依从性也较低（0.55，95%置信区间：0.40 - 0.76）。在其他地区未发现显著差异。
在卒中/TIA后，亚洲和大洋洲出生的参与者在药物依从性方面存在出生地区差异。有必要针对这些群体的需求开展有针对性的教育，以提高药物依从性。
