Living in low-resource neighborhood impacts adherence to heart failure medications
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Key takeaways:
- Adults living in disadvantaged neighborhoods were less likely to take guideline-directed HF medications as prescribed.
- Transportation access and pharmacy density did not mediate the findings.
Adults with HF who live in economically disadvantaged neighborhoods were significantly less likely to take guideline-directed therapies as prescribed, underscoring the importance of considering social determinants of health in patient care.
“Patients with HF have high rates of morbidity and mortality and there are a lot of therapies that can help improve HF outcomes but that requires that patients take their medicines,” Saul Blecker, MD, associate professor in the department of population health at NYU Grossman School of Medicine, told Healio. “We were interested in looking at patients living in disadvantaged areas who may be at higher risk for not taking their medicines due to many different barriers, such as lower access to transportation or pharmacies. Some data show lower socioeconomic status is associated with medication adherence, but there is little data related to HF, which requires a complex regimen of medications.”
Data were derived from Mukhopadhyay A, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.47519.
In a retrospective study, Blecker, Amrita Mukhopadhyay, MD, cardiologist and clinical investigator in the department of medicine at NYU Langone Health, and colleagues analyzed data from 6,247 adults with a diagnosis of HFrEF and a prescription for at least one guideline-directed medical therapy (GDMT) for HFrEF between June 2020 and December 2021. The mean age of patients was 73 years; 69.5% were men; 16.2% were Black and 11.8% were Hispanic. Researchers geocoded patients’ addresses and calculated neighborhood socioeconomic status using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value and education, with higher values indicating higher socioeconomic status.
Researchers assessed medication adherence through electronic prescription data, with nonadherence defined as proportion of days covered of less than 80% over 6 months, averaged across GDMT medications.
The findings were published in JAMA Network Open.
Patients living in areas defined as lower in socioeconomic status had higher rates of nonadherence, ranging from 51.7% in the lowest quartile to 40% in the highest quartile (P < .001).
In an adjusted analysis, patients living in the lower two quartiles of neighborhood socioeconomic status had higher odds of nonadherence compared with patients living in the highest neighborhood socioeconomic status quartile, with an OR of 1.57 for quartile 1 (95% CI, 1.35-1.83) and an OR of 1.35 for quartile 2 (95% CI, 1.16- 1.56).
In mediation analyses, findings did not change when factoring in transportation access or the number of pharmacies located in neighborhoods, Blecker said. Researchers did find neighborhood walkability had a small impact on adherence.
“We thought these built environment factors would affect things,” Blecker said during an interview. “That was the more surprising piece of the results, because it would be nice to say ‘These are the factors that explain this, let’s put more pharmacies in neighborhoods with lower socioeconomic status.’ Clearly, there are many things going on.”
Blecker said research is ongoing on whether factors such as distance of neighborhood pharmacies, pharmacy hours and language concordance in pharmacies might be associated with medication adherence in HF.
“We also are looking at medication costs,” Blecker told Healio. “Neighborhood-level socioeconomic status is not a perfect marker for individual-level socioeconomic status, but still may reflect that people potentially have lower income compared with those living in other neighborhoods and may be more cost-sensitive. Some of these medications can cost a lot. We are trying to understand the effect of the cost of medications and how that may influence medication-taking behaviors.”
For more information:
Saul Blecker, MD, can be reached at saul.blecker@nyulangone.org.
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