The association of social determinants of health and medication adherence: A cross-sectional analysis across three urban emergency departments.

INTRODUCTION

Social determinants of health (SDoH), including factors like income, education, and housing, can influence health outcomes and medication adherence, especially among emergency department (ED) patients. This study explores the relationship between SDoH and medication adherence among patients in urban EDs.

METHODS

We conducted a cross-sectional survey across three geographically diverse urban EDs from May 2022 to February 2024 among ED patients aged ≥18 who were taking ≥4 prescription medications or ≥ 1 "high-risk" medication, including immunosuppressants, antiepileptics, sedatives, anti-Parkinson agents, antithrombotics, antihyperglycemics, or cardiovascular medications. The AAFP Social Needs Screening Tool and a validated medication adherence questionnaire were used. Data were analyzed using univariate and multivariable logistic regression to identify associations between SDoH and medication adherence.

RESULTS

345 participants completed the survey. Among survey respondents, 28 % delayed medical visits due to transportation issues, while 31.9 % faced financial difficulties. Housing instability was reported by 16.3 % of participants. Regarding medication adherence, 42.4 % of patients forgot to take their medications, 23.7 % skipped doses, and 34.8 % missed appointments. Multivariate analysis revealed that younger patients (<65 years) were more likely to experience running out of medications. Financial instability and transportation difficulties were also associated with poor adherence to prescribed medications and increased difficulty with healthcare utilization tasks.

CONCLUSION

This study highlights the associations of SDoH with medication adherence in urban ED settings. Transportation, financial, and housing challenges were associated with greater odds of exhibiting poor medication adherence. Younger patients also demonstrated higher rates of non-adherence. Addressing these SDoH through targeted interventions could improve medication adherence and overall health outcomes.