This study tried to investigate the effects of number of medications and age on antihypertensive medication adherence in a real-world setting using a nationwide representative cohort. We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea, which is a sample of 2.2% (N = 1,048,061) of total population (N = 46,605,433). Patients aged 20 years or older (N = 150,550) who took antihypertensive medications for at least 1 year were selected. Medication possession ratio (MPR) was used for measuring adherence. The subjects were divided into 5 subgroups according to total number of medications: 1–2, 3–4, 5–6, 7–8, and 9 or more. The mean age and the mean number of medications were 60.3 ± 12.6 years and 4.1 ± 2.2, respectively. The mean MPR was 80.4 ± 23.9%, and 66.9% (N = 100,645) of total subjects were adherent (MPR ≥ 80%). The overall tendency of antihypertensive medication adherence according to the total number of medications displayed an inverted U-shape with a peak at 3–4 drugs. Adherence consistently increased as the age increased until age 69 and started to decrease from age 70. The proportion of adherent patients (MPR ≥ 80%) according to the total number of medications also showed an inverted U-shape with a peak at 3–4 drugs. When the same number of drugs was taken, the proportion of adherent patients according to age featured an inverted U- shape with a peak at 60 to 69 years. Patients taking 9 or more total drugs had the overall odds ratio (95% CI) of non-adherence (MPR < 80%) with 1.17 (1.11–1.24) compared with those taking 1 to 8 total drugs and the odds ratios in the age subgroups of 40 to 49, 50 to 59, 60 to 69 years were 1.57 (1.31–1.87), 1.21 (1.08–1.36), and 1.14 (1.04–1.25), respectively (P < .05). Association between age, total number of medications, and antihypertensive adherence displayed an inverted U-shape with a peak at 3 to 4 total medications and at age 60 to 69 years. When the total number of drugs was 9 or more, adherence decreased prominently, regardless of age.
Background: This study aimed to investigate the relationship between residential area and antihypertensive medication adherence in Seoul, the representative metropolis of Korea. Methods: We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea covering the years 2008-2013.NHIS-NSC curates a random data sample comprising 2.2% (N=1,048,061) of the whole population (N=46,605,433). The subject pool consisted of 35,478 residents of Seoul over 20 years of age, who had been on an antihypertensive medication for at least one year. Medication adherence was assessed using the medication possession ratio (MPR). We divided subjects by administrative district (Gu) within Seoul, and analyzed proportions of adherent patients. Results: Among administrative districts in Seoul, the proportion of adherent patients (MPR >80%) was highest in Gangdong-gu (71.8%), with Seongdong-gu (71.7%), Songpa-gu (71.4%), and Jung-gu (70.9%) closely following. The proportion of adherent patients was lowest in Gwanak-gu (65.4%), and Jongro-gu (65.5%), with Geumcheon-gu (65.7%) slightly higher. Trends in proportion of adherent patients among districts remained similar after adjustments were made for confounding factors at the individual level. Trends also remained similar after adjusting for confounding factors at the local level. Conclusion:Health system factors such as distribution and accessibility of medical institutions by administrative districts exerted relatively little influence on antihypertensive medication adherence in Seoul.
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