Geosocial Factors Associated With Adherence to Statin Medications

Erickson, Steven R.; Bravo, Mercedes A.; Tootoo, Joshua

doi:10.1177/1060028020934879

Cited by 7 publications

(9 citation statements)

References 41 publications

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“…to some overseas studies [44][45][46], we did not find an association between socioeconomic status and statin adherence except for patients living in the most deprived areas. This may partly reflect the variation in how socioeconomic status is measured across countries and studies.…”

Section: Plos Onecontrasting

confidence: 96%

Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

2020

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Background Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. Methods Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. Results Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51–1.59) times as likely to be adherent and 0.67 (95% CI 0.65–0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. Conclusion Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.

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Section: Plos Onecontrasting

confidence: 96%

Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

2020

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“…No association was found for distance to most frequently utilised pharmacy in this study. This finding aligns with two other studies, one involving n=6532 T2DM patients enrolled in Medicaid in the Greater Chicago region, which focused on adherence to angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers ( Syed et al, 2016 ), and another which focused on n = 174,146 persons enrolled in commercial insurance products in Michigan taking statin medication ( Erickson et al, 2020 ). Walgreens®, a nationwide U.S. pharmacy chain, claims that 76 percent of the entire U.S. population is within 5 miles of a Walgreens® pharmacy, and 40 percent of Medically Underserved Areas are within a 15-min drive-time of a Walgreens® pharmacy ( Taitel, 2019 ).…”

Section: Discussionsupporting

confidence: 86%

“…The finding that T2DM patients living in areas with greater social vulnerability were more likely to be non-adherent after adjustment for individual factors is supported by a recent study of patients undergoing statin therapy, where associations were observed between lower levels of adherence and lower neighbourhood socioeconomic status and urban-versus rural-dwelling residents ( Erickson, Bravo, & Tootoo, 2020 ). This is the first time to our knowledge that the CDC/ATSDR Social Vulnerability Index has been used to study potential social determinants of medication adherence.…”

Section: Discussionmentioning

confidence: 85%

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Learnihan

Schroers

Coote

et al. 2022

SSM - Population Health

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Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.

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“…Statin adherence has been reported to be associated with higher socioeconomic status and higher educational attainment. 17 , 18 A Swedish study found that patients with ≤ 9 years of education were less likely to use statin medications compared to patients with more than 12 years of educational attainment (odds ratio: 0.89 (95% CI: 0.84–0.94). 33 However, the finding is not consistent.…”

Section: Discussionmentioning

confidence: 99%

“…In that case, socioeconomic and demographic characteristics of statin users may have changed over the last decades, but this possibility has not been addressed by the existing literature. Furthermore, statin adherence has been associated with higher socioeconomic status, [15][16][17][18] which is associated with longer survival in patients with cirrhosis. 19 Therefore, it remains unclear if some of the beneficial effects attributed to statin use could in fact be caused by favourable socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Statin Use and Predictors of Statin Initiation Among Patients with Alcohol-Related Cirrhosis - A Danish Nationwide Cohort Study

Ramsing¹,

Kraglund²,

Jepsen³

2023

CLEP

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Purpose Statins reportedly increase the survival of patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis), but this association might be confounded by socioeconomic status. We examined the prevalence of statin use and socioeconomic and demographic predictors of statin initiation and discontinuation among patients with ALD cirrhosis. Patients and Methods Using Danish nationwide healthcare registries, we examined statin use among patients diagnosed with ALD cirrhosis in 1997–2018. We computed the prevalence of statin use and incidence of statin initiation and discontinuation, and we used multivariable Cox regression to identify predictors of statin initiation and discontinuation. Results We identified 28,260 patients with ALD cirrhosis in 1997–2018. During this period, the prevalence of statin use rose sharply, reaching 19.0% in late 2018. Among patients diagnosed with ALD cirrhosis after 2010, 16.9% were using statins when they were diagnosed with cirrhosis. Among the patients who did not use statins initially, those with lower educational attainment were more likely to begin taking them than those with higher attainment. Also, cohabiting patients were more likely to begin than patients who lived alone, and employed patients were more likely to begin compared to patients outside the labour force. Among current statin users, unemployment predicted statin discontinuation. Conclusion The use of statins has become increasingly prevalent among Danish patients with ALD cirrhosis, reaching 19.0% in 2018. Employment, cohabitation, and a short education predicted statin initiation after ALD cirrhosis diagnosis, and unemployment predicted statin discontinuation. Overall, statin use was not a marker of a high socioeconomic status.

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Geosocial Factors Associated With Adherence to Statin Medications

Cited by 7 publications

References 41 publications

Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Prevalence of Statin Use and Predictors of Statin Initiation Among Patients with Alcohol-Related Cirrhosis - A Danish Nationwide Cohort Study

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