Low adherence with antihypertensives in actual practice: the association with social participation--a multilevel analysis.
BACKGROUND
Low adherence is a key factor in explaining impaired effectiveness and efficiency in the pharmacological treatment of hypertension. However, little is known about which factors determine low adherence in actual practice. The purpose of this study is to examine whether low social participation is associated with low adherence with antihypertensive medication, and if this association is modified by the municipality of residence.


METHODS
1288 users of antihypertensive medication were identified from The Health Survey in Scania 2000, Sweden. The outcome was low adherence with antihypertensives during the last two weeks. Multilevel logistic regression with participants at the first level and municipalities at the second level was used for analyses of the data.


RESULTS
Low social participation was associated with low adherence with antihypertensives during the last two weeks (OR = 2.05, 95% CI: 1.05-3.99), independently of low educational level. However, after additional adjustment for poor self-rated health and poor psychological health, the association between low social participation and low adherence with antihypertensives during the last two weeks remained but was not conclusive (OR = 1.80, 95% CI: 0.90-3.61). Furthermore, the association between low social participation and low adherence with antihypertensives during the last two weeks varied among municipalities in Scania (i.e., cross-level interaction).


CONCLUSIONS
Low social participation seems to be associated with low adherence with antihypertensives during the last two weeks, and this association may be modified by the municipality of residence. Future studies aimed at investigating health-related behaviours in general and low adherence with medication in particular might benefit if they consider area of residence.
Johnell
Kristina
K
Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden. Kristina.Johnell@klinvet.ki.se
Råstam
Lennart
L
Lithman
Thor
T
Sundquist
Jan
J
Merlo
Juan
J
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011593:Psychology, Social; D012111:Residence Characteristics; D012931:Social Environment; D012938:Social Perception; D012944:Social Support; D013548:Sweden; D016896:Treatment Outcome
D000959:Antihypertensive Agents
J Psychosom Res. 1999 Dec;47(6):555-67
10661603
J Epidemiol Community Health. 2005 Jun;59(6):443-9
15911637
Blood Press Monit. 2000;5 Suppl 1:S31-4
10904240
Soc Sci Med. 2000 Sep;51(6):843-57
10972429
Curr Hypertens Rep. 1999 Dec;1(6):502-6
10981113
Control Clin Trials. 2000 Oct;21(5 Suppl):184S-7S
11018573
Curr Hypertens Rep. 2000 Dec;2(6):515-24
11062596
Int J Epidemiol. 2001 Apr;30(2):326-33
11369738
Arch Intern Med. 2001 Jun 11;161(11):1443-7
11386894
J Hypertens Suppl. 2001 Sep;19(3):S33-40
11713849
Lancet. 2002 Jun 22;359(9324):2129-30
12090976
Soc Sci Med. 2002 Jun;54(12):1779-91
12113435
Am J Epidemiol. 2003 May 1;157(9):774-83
12727671
Aust N Z J Psychiatry. 2003 Jun;37(3):374-81
12780478
J Epidemiol Community Health. 2003 Aug;57(8):550-2
12883048
Pharmacoepidemiol Drug Saf. 2003 Oct-Nov;12(7):551-8
14558178
Am J Epidemiol. 2004 Jun 15;159(12):1168-79
15191934
Arch Intern Med. 1977 Mar;137(3):318-321
843149
Med Care. 1986 Jan;24(1):67-74
3945130
Hypertension. 1989 May;13(5 Suppl):I66-8
2490830
Arch Intern Med. 1993 Aug 23;153(16):1869-78
8250648
J Hypertens. 1994 Apr;12(4):481-90
8064174
BMJ. 1996 May 11;312(7040):1215-8
8634569
J Hum Hypertens. 1996 May;10(5):299-303
8817403
Circulation. 1997 Feb 18;95(4):1085-90
9054774
Soc Sci Med. 1998 Jan;46(1):97-117
9464672
BMJ. 1998 Aug 8;317(7155):409-10
9694763
CMAJ. 1999 Jan 12;160(1):31-7
9934341
Health Place. 2000 Jun;6(2):67-79
10785349