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A National Assessment of Medication Adherence to Statins by the Racial Composition of Neighborhoods

  • Andrew M. DavisEmail author
  • Michael S. Taitel
  • Jenny Jiang
  • Dima M. Qato
  • Monica E. Peek
  • Chia-Hung Chou
  • Elbert S. Huang
Article

Abstract

Adherence to statins is lower in black and Hispanic patients and is linked to racial/ethnic disparities in cardiovascular mortality. Poverty, education, and prescription coverage differentials are typically invoked to explain adherence disparities, but analyses at the level of neighborhoods and their pharmacies may provide additional insights. Among individuals filling new statin prescriptions in a national pharmacy chain (N = 326,171), we compared adherence for patients residing in mostly minority neighborhoods to those living in mainly white areas. In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in black and Hispanic neighborhoods had 2–3 weeks less statin therapy over 1 year, a pattern not seen in Asian areas. In black and Hispanic neighborhoods, good adherence was associated with co-pays under $10, the use of 90-day refills, and payers other than Medicaid. Efforts to improve medication adherence for vulnerable populations may benefit from interventions at the level of local pharmacies, as well as medication benefit redesign.

Keywords

Racial and ethnic disparities Medication adherence Statin therapy Cardiovascular disease Neighborhood Pharmacies 

Notes

Compliance with Ethical Standards

Conflict of Interest

Michael S. Taitel and Jenny Jiang are employees of Walgreen Company. The remaining authors (Davis, Peek, Chou, Qato, and Huang) all declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

IRB Review

The study protocol was approved by the Quorum Review IRB. All analysis was conducted on aggregate, deindentified data.

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Copyright information

© W. Montague Cobb-NMA Health Institute 2016

Authors and Affiliations

  • Andrew M. Davis
    • 1
    Email author
  • Michael S. Taitel
    • 2
  • Jenny Jiang
    • 2
  • Dima M. Qato
    • 3
  • Monica E. Peek
    • 1
  • Chia-Hung Chou
    • 1
  • Elbert S. Huang
    • 1
  1. 1.Division of General Internal MedicineUniversity of ChicagoChicagoUSA
  2. 2.Clinical Outcomes and Analytic Services, Walgreen CoDeerfieldUSA
  3. 3.Department of Pharmacy Systems, Outcomes, and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois College of PharmacyChicagoUSA

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