Oates Gabriela R, Riekert Kristin A, Ford Christine, Dickinson Kimberly M, Butcher Jennifer L, Naranjo Diana, Phan Hanna, Daines Cori, Grabowski Hannah, Schechter Michael S
Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Pediatr Pulmonol. 2025 Aug;60(8):e71230. doi: 10.1002/ppul.71230.
Medication adherence is essential in managing cystic fibrosis (CF). The role of socioeconomic factors for medication adherence in people with CF is poorly understood, and their differential impact across the life course is underexplored. This study investigates associations between measures of socioeconomic status (SES)-educational attainment, household income, and health insurance type-and adherence to CF medications across age groups.
We conducted a cross-sectional analysis of data collected during the validation of the Daily Care Check-In, a measure of adherence barriers in people with CF. Adherence was measured as a composite medication possession ratio (cMPR) averaged across five CF-specific medications, with data collected from pharmacy records. Sociodemographic and clinical data were collected through self-report and medical record review.
A total of 405 participants completed the study, with an overall cMPR of 45.6%, lowest (38.5%) among young adults (aged 18-26 years) and highest (53.0%) among adolescents (aged 13-17 years). Lower household income and lack of college degree were associated with lower cMPR, more interference from adherence barriers, and decreased self-efficacy, as well as with increased depressive and anxiety symptoms. Similar associations, but less consistent, were observed for public health insurance. When stratified by age, associations between SES measures and adherence were most evident in adolescents, followed by adults, but absent in young adults, bringing into focus challenges with measuring SES in the 18-25 years age group.
Lower SES is associated with worse medication adherence, more interference from adherence barriers, and lower self-efficacy. Associations vary by SES measure and age group, calling for a nuanced approach to adherence interventions in this population.
药物依从性对于囊性纤维化（CF）的管理至关重要。社会经济因素对CF患者药物依从性的作用了解甚少，其在整个生命过程中的差异影响也未得到充分探索。本研究调查社会经济地位（SES）指标——教育程度、家庭收入和医疗保险类型——与各年龄组CF药物依从性之间的关联。
我们对在日常护理签到验证期间收集的数据进行了横断面分析，日常护理签到是一种衡量CF患者依从性障碍的方法。依从性通过五种CF特异性药物的平均复合药物持有率（cMPR）来衡量，数据从药房记录中收集。社会人口统计学和临床数据通过自我报告和病历审查收集。
共有405名参与者完成了研究，总体cMPR为45.6%，在年轻人（18 - 26岁）中最低（38.5%），在青少年（13 - 17岁）中最高（53.0%）。较低的家庭收入和缺乏大学学位与较低的cMPR、依从性障碍的更多干扰、自我效能感降低以及抑郁和焦虑症状增加有关。对于公共医疗保险，观察到类似的关联，但不太一致。按年龄分层时，SES指标与依从性之间的关联在青少年中最为明显，其次是成年人，但在年轻人中不存在，这凸显了在18 - 25岁年龄组中衡量SES的挑战。
较低的SES与较差的药物依从性、依从性障碍的更多干扰以及较低的自我效能感相关。关联因SES指标和年龄组而异，这就要求在该人群中采取细致入微的依从性干预方法。
