Elsevier

American Heart Journal

Volume 200, June 2018, Pages 51-59
American Heart Journal

Clinical Investigation
Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study

https://doi.org/10.1016/j.ahj.2018.03.007Get rights and content

Abstract

Background

Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions.

Methods and Results

We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination.

Conclusion

Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.

Section snippets

Data sources

The JHS is a prospective community-based observational study of 5306 African Americans designed to investigate risk factors for cardiovascular disease.11 Initiated in 2000, all study participants provided written informed consent, and study protocols were approved by local institutional review boards. Participants were recruited from the Jackson, Mississippi cohort of the Atherosclerosis Risk in Communities study and the overall tricounty population.12 Participants completed 3 study visits:

Results

Figure 1 presents the details for the analysis cohort using self-reported adherence data from the baseline exam. Of 2933 participants routinely taking medications at baseline, 2138 (72.9%) reported non-adherence. Of these participants, 754 (35.3%) reported only unintentional non-adherence, 263 (12.3%) reported only intentional non-adherence, and 1121 (52.4%) both intentional and unintentional non-adherence.

Table II presents the baseline characteristics by adherence status. Compared with those

Discussion

Among African Americans in the JHS, more than 70% of participants taking medications for chronic conditions reported non-adherence at baseline, with more than half of those reporting non-adherence having some degree of both intentional and unintentional non-adherence. The number of medications being taken and medication classes were was similar between those reporting and not reporting non-adherence. Factors independently associated with unintentional non-adherence included younger age and

Conclusion

More than 70% of participants taking medications for chronic conditions in the current study reported non-adherence. Approximately half of these participants reported both intentional and unintentional reasons for non-adherence. Specific participant factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other factors. These findings provide a

Acknowledgments

The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201300049C and HHSN268201300050C), Tougaloo College (HHSN268201300048C), and the University of Mississippi Medical Center (HHSN268201300046C and HHSN268201300047C) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). The authors also wish to thank the staffs and participants of the JHS.

Disclosures

RJM receives research support from the National Institutes of Health (U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bayer, GlaxoSmithKline, Gilead, Luitpold, Merck, Novartis, and Otsuka. Dr. Daichi Shimbo is a consultant for Abbott Vascular and Novartis Pharmaceuticals Corporation. The remaining authors report no relevant conflicts of interest.

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    Funding: This work was supported by grant R01HL117305, K24 HL125704 and R01HL117323 from the National Heart, Lung, And Blood Institute. The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The authors thank the participants and data collection staff of the Jackson Heart Study. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

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