Antihypertensive adherence and drug class among Asian Pacific Americans.
OBJECTIVE
Research on adherence has emphasized the need to consider patient ethnicity when developing adherence plans. The objective of this study is to identify predictors of adherence for specific groups, particularly Asian Americans and Pacific Islanders.


METHODS
We examined the factors, including drug class, associated with antihypertensive adherence for 28,395 adults in Hawaii (July 1999-June 2003) using health plan administrative data. The population included Japanese (n=13,836), Filipino (n=3,812), Chinese (n=2,280), Korean (n=450), part-Hawaiian (n=3,746) and white (n=3,920) patients. Members with antihypertensive medication in their possession >or=80% of the time were considered adherent. Multivariable logistic regression models were used to identify factors associated with adherence.


RESULTS
Overall adherence rates were less than 65% among all racial/ethnic groups. After adjustment for patient age, gender, morbidity level, health plan type, isle of residence, comorbidities and year of treatment, Japanese were more likely than whites to adhere to antihypertensive therapy [OR=1.21 (1.14-1.29)], whereas Filipino [OR=0.69 (0.64-0.74)], Korean [OR=0.79 (0.67-0.93)] and Hawaiian [OR=0.84 (0.78-0.91)] patients were less likely to adhere. These results were consistent across therapeutic class. Other patient factors associated with lower adherence included younger age, higher morbidity and history of heart disease. Patient factors were also significantly related to adherence, including gender and seeing a sub-specialist. Seeing a physician of the same ethnicity did not appear to improve adherence.


CONCLUSIONS
Our findings of substantial disparities among Asian Pacific American subgroups highlight the need to examine subgroups separately. Future qualitative research is needed to determine appropriate interventions, particularly for Filipino, Korean and Hawaiian patients.
Taira
Deborah A
DA
Hawaii Medical Service Association, Honolulu, HI 96813, USA. deb_taira@hmsa.com
Gelber
Rebecca P
RP
Davis
James
J
Gronley
Krista
K
Chung
Richard S
RS
Seto
Todd B
TB
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D001213:Asian / Q000523:psychology*; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology*; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044468:Native Hawaiian or Pacific Islander / Q000523:psychology*; D016017:Odds Ratio; D010349:Patient Compliance / Q000208:ethnology*; D012307:Risk Factors; D044465:White People / Q000523:psychology
D000959:Antihypertensive Agents