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Disparity seen in medication persistence across ethnic groups in type 2 diabetes

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NEW ORLEANS — Researchers found a “vast disparity” in medication persistence for type 2 diabetes drugs across different ethnic groups in the U.K., particularly for black and Asian adults, according to a speaker at the American Diabetes Association Scientific Sessions.

“Black and Asian people had a crude medication persistence which was less than half that of white people,” Andrew McGovern, BMBS, of the University of Surrey, told Endocrine Today. “After adjusting for confounders of medication adherence, this difference was hardly diminished.

In a retrospective cohort study, McGovern and colleagues analyzed data from 58,717 adults with type 2 diabetes from 127 primary care practices across England. Researchers compared persistence in all non-insulin medications from January 2004 to July 2015; nonpersistence was defined as a medication gap of at least 90 days. Researchers used Cox proportional hazard models adjusted for age, socioeconomic deprivation, alcohol and smoking use, HbA1c, duration of diabetes, presence of complications and comorbidities, and number of concurrent and previous medications.

Researchers found white adults had the highest crude median persistence at 2.53 years (95% CI, 2.49-2.58), followed by mixed ethnicities at a median of 1.47 years (95% CI, 1.26-1.80) and other ethnicities at a median of 1.37 years (95% CI, 1.23-1.52). Asian adults had a median persistence of 1.11 years (95% CI, 1.05-1.17); black adults had a median persistence of 0.93 years (95% CI, 0.87-1.03).

After multivariable adjustment, HRs for nonpersistence were highest among black adults (HR = 1.82; 95% CI, 1.763-1.92), followed by other ethnicities (HR = 1.65; 95% CI, 1.46-1.86), Asian adults (HR = 1.61; 95% CI, 1.05-1.66) and mixed ethnicities (HR = 1.37; 95% CI, 1.23-1.52).

McGovern noted that the U.K. dataset drew from a large sample of real-world data, and the universal health care system in England minimizes the impact of disparity caused by cost and access to health care; however, it was not possible to explore the reasons behind the associations between persistence and ethnicity.

“As clinicians, we need to be asking the following questions,” McGovern said. “Are we inquiring about adherence to medications in non-white groups? Are we providing information to our patients which is culturally tailored? Are we doing what we can to overcome any ethnic, language and cultural barriers to help patients take their medications as prescribed?”

“We need to investigate what is causing this large disparity in medication use across different ethnic groups,” McGovern told Endocrine Today. “Only then can we target interventions to improve these differences.” – by Regina Schaffer

Reference:

McGovern AP, et al. 86-OR. Presented at: American Diabetes Association 76th Scientific Sessions; June 10-14, 2016; New Orleans.

Disclosure: Eli Lilly and Company funding this study. McGovern reports no relevant financial disclosures.