title: Race-ethnicity, crime, and other factors associated with adherence to inhaled corticosteroids.
abstract: BACKGROUND
  Previous studies have shown differences in adherence to inhaled corticosteroids (ICSs) by race-ethnicity, yet little is known about factors that contribute to adherence within these groups. Environmental stressors, such as crime exposure, which has been associated with asthma morbidity, might also predict ICS adherence.
  
  
  OBJECTIVE
  We sought to identify factors associated with ICS adherence among patients with asthma and among African American patients and white patients separately.
  
  
  METHODS
  Study patients with asthma were aged 18 to 50 years and were enrolled in a large southeast Michigan health maintenance organization between January 1, 1999, and December 31, 2001. The primary outcome, ICS adherence, was calculated by linking prescription-fill data with dosage information. Predictor variables included age, sex, race-ethnicity, measures of socioeconomic status (SES), average ICS copay, existing comorbidities, and crime rate in area of residence.
  
  
  RESULTS
  Adherence information was available for 176 patients. ICS adherence was lower among African American patients (n = 75) when compared with white patients (n = 94; 40% vs 58%, respectively; P = .002). Among white patients, adherence was significantly lower for women when compared with men. Among African American patients, age and residential crime rates were positively and negatively associated with ICS adherence, respectively. Area crime remained a predictor of adherence in African American patients, even after adjusting for multiple measures of SES.
  
  
  CONCLUSIONS
  This study suggests that an environmental stressor, area crime, provides additional predictive insight into ICS-adherent behavior beyond typical SES factors.
  
  
  CONCLUSIONS
  Better understanding of environmental factors that influence ICS adherence might aid in efforts to improve it.
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, USA. kwillia5@hfhs.org
authors.forename: L Keoki
authors.initials: LK
authors.lastname: Williams
authors.forename: Christine L
authors.initials: CL
authors.lastname: Joseph
authors.forename: Edward L
authors.initials: EL
authors.lastname: Peterson
authors.forename: Christina
authors.initials: C
authors.lastname: Moon
authors.forename: Hugo
authors.initials: H
authors.lastname: Xi
authors.forename: Richard
authors.initials: R
authors.lastname: Krajenta
authors.forename: Reba
authors.initials: R
authors.lastname: Johnson
authors.forename: Karen
authors.initials: K
authors.lastname: Wells
authors.forename: Jason C
authors.initials: JC
authors.lastname: Booza
authors.forename: Kaan
authors.initials: K
authors.lastname: Tunceli
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lafata
authors.forename: Christine C
authors.initials: CC
authors.lastname: Johnson
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Ownby
authors.forename: Robert
authors.initials: R
authors.lastname: Enberg
authors.forename: Manel
authors.initials: M
authors.lastname: Pladevall
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001741:Black or African American; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D003415:Crime / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000208:ethnology*; D044465:White People
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents