Journal article
Antihypertensive Adherence Trajectories Among Older Adults in the First Year After Initiation of Therapy
American journal of hypertension, Vol.30(10), pp.1015-1023
10/01/2017
DOI: 10.1093/ajh/hpx086
PMCID: PMC7190965
PMID: 28535297
Abstract
Adherence to antihypertensives is suboptimal, but previous methods of quantifying adherence fail to account for varying patterns of use over time. We sought to improve classification of antihypertensive adherence using group-based trajectory models, and to determine whether individual factors predict adherence trajectories.
We identified older adults initiating antihypertensive therapy during 2008-2011 using a 20% sample of Medicare (federal health insurance available to US residents over the age of 65) beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication). We developed monthly adherence indicators using prescription fill dates and days supply data in the 12 months following initiation. Adherence was defined as having at least 80% of days covered. Logistic models were used to identify trajectory groups. Bayesian information criterion and trajectory group size were used to select the optimal trajectory model. We compared the distribution of covariates across trajectory groups using multivariable logistic regression.
During 2008-2011, 282,520 Medicare beneficiaries initiated antihypertensive therapy (mean age 75 years, 60% women, 84% White). Six trajectories were identified ranging from perfect adherence (12-month adherence of 0.97, 40% of beneficiaries) to immediate stopping (12-month adherence of 0.10, 18% of beneficiaries). The strongest predictors of nonadherence were initiation with a single antihypertensive class (adjusted odds ratio = 2.08 (95% confidence interval: 2.00-2.13)), Hispanic (2.93 (2.75-3.11)) or Black race/ethnicity (2.04 (1.95-2.13)), and no prior history of hypertension (2.04 (2.00-2.08)) (Area under the receiving operating characteristic curve: 0.53).
There is substantial variation in antihypertensive adherence among older adults. Certain patient characteristics are likely determinants of antihypertensive adherence trajectories.
Details
- Title: Subtitle
- Antihypertensive Adherence Trajectories Among Older Adults in the First Year After Initiation of Therapy
- Creators
- Jennifer L Hargrove - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAVirginia Pate - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USACarri H Casteel - College of Public Health, The University of Iowa, Iowa City, Iowa, USAYvonne M Golightly - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USALaura R Loehr - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAStephen W Marshall - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USATil Stürmer - Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Resource Type
- Journal article
- Publication Details
- American journal of hypertension, Vol.30(10), pp.1015-1023
- DOI
- 10.1093/ajh/hpx086
- PMID
- 28535297
- PMCID
- PMC7190965
- NLM abbreviation
- Am J Hypertens
- ISSN
- 1941-7225
- eISSN
- 1879-1905
- Publisher
- United States
- Grant note
- R01 AG023178 / NIA NIH HHS R56 AG023178 / NIA NIH HHS
- Language
- English
- Date published
- 10/01/2017
- Academic Unit
- Occupational and Environmental Health; Epidemiology; Injury Prevention Research Center
- Record Identifier
- 9983997475302771
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