Relationships Between Antihypertensive, Glucose- and Lipid-Lowering Medication Adherence, and Demographic and Clinical Characteristics in American Indian Adults With Type 2 Diabetes.

内容摘要

This study examined the relationships between medication adherence and demographic and clinical characteristics in American Indian adults with Type 2 diabetes who live on tribal lands and receive medication at no cost to them. From tribal electronic health record data, we constructed a cross-sectional cohort of 3042 adults with Type 2 diabetes. Tribal citizens of a federally recognized tribe were included if aged &#x2265;&#x2009;18 years, had Type 2 diabetes, had &#x2265;&#x2009;1 Choctaw Nation of Oklahoma healthcare encounter in 2018, and were on antihypertensive, glucose- and lipid-lowering medications in 2018. Proportion of days covered (PDC) was used to assess medication adherence with a threshold of &#x2265;&#x2009;80%. The cohort mean age was 59.3 &#xb1; 11.6&#x2009;years; the majority were male (52%), married (52%), BMI &#x2265; 30 (74%), and lived in a rural setting (87%). Overall, 63% of patients were adherent to their medications with a mean PDC across all medication classes of 0.81 &#xb1; 0.18. Patients aged >&#x2009;55 years had a significantly higher PDC across all three medication classes compared with those aged &#x2264;&#x2009;55 years (84% vs. 77%, p < 0.001). Also, BMI &#x2265; 30 (&#x3b2; = 0.033, p < 0.001) or having a comorbid condition (&#x3b2; = 0.040, p < 0.001) were each associated with higher overall PDC. Whereas insulin use (&#x3b2; = -0.023, p = 0.001) and rural residence (&#x3b2; = -0.020, p = 0.03) were associated with lower overall PDC. Additionally, patients with comorbid kidney or heart disease had a higher overall PDC compared with those without these conditions (p < 0.001). In a setting with access to no-cost medication, nearly two-thirds of our sample were considered adherent to their medications. Older adults and those with comorbid conditions or BMI &#x2265; 30 had higher overall adherence to medications, whereas those residing in rural areas or using insulin had lower overall medication adherence.