Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis

Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased morta...

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Autores principales: Donneyong, Macarius M., Fischer, Michael A., Langston, Michael A., Joseph, Joshua J., Juarez, Paul D., Zhang, Ping, Kline, David M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657217/
https://www.ncbi.nlm.nih.gov/pubmed/34886429
http://dx.doi.org/10.3390/ijerph182312702
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author Donneyong, Macarius M.
Fischer, Michael A.
Langston, Michael A.
Joseph, Joshua J.
Juarez, Paul D.
Zhang, Ping
Kline, David M.
author_facet Donneyong, Macarius M.
Fischer, Michael A.
Langston, Michael A.
Joseph, Joshua J.
Juarez, Paul D.
Zhang, Ping
Kline, David M.
author_sort Donneyong, Macarius M.
collection PubMed
description Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.
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spelling pubmed-86572172021-12-10 Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis Donneyong, Macarius M. Fischer, Michael A. Langston, Michael A. Joseph, Joshua J. Juarez, Paul D. Zhang, Ping Kline, David M. Int J Environ Res Public Health Article Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke. MDPI 2021-12-02 /pmc/articles/PMC8657217/ /pubmed/34886429 http://dx.doi.org/10.3390/ijerph182312702 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Donneyong, Macarius M.
Fischer, Michael A.
Langston, Michael A.
Joseph, Joshua J.
Juarez, Paul D.
Zhang, Ping
Kline, David M.
Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title_full Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title_fullStr Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title_full_unstemmed Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title_short Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis
title_sort examining the drivers of racial/ethnic disparities in non-adherence to antihypertensive medications and mortality due to heart disease and stroke: a county-level analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657217/
https://www.ncbi.nlm.nih.gov/pubmed/34886429
http://dx.doi.org/10.3390/ijerph182312702
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