title: The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children.
abstract: OBJECTIVE
  To investigate the association of ethnicity with objectively, electronically measured adherence to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in the city of Amsterdam.
  
  
  METHODS
  The study was designed as a prospective, observational multicenter study in which adherence to ICS and potential risk factors for adherence to ICS were measured in a cohort of Moroccan and native Dutch children with asthma. Electronic adherence measurements were performed for 3 months per patient using a Real Time Medication Monitoring (RTMM) system. Ethnicity and other potential risk factors, such as socio-economic status, asthma control and parental medication beliefs, were extracted from medical records or parent interviews. The association between adherence and ethnicity was analysed using multivariate linear regression analysis.
  
  
  RESULTS
  A total of 90 children (aged 1-11 years) were included in the study and data of 87 children were used for analysis. Average adherence to ICS was 49.3 %. Native Dutch children showed higher adherence to ICS than Moroccan children (55.9 vs. 42.5 %, respectively; p = 0.044, univariate analysis). After correction for confounders (>3 annual visits to the paediatric outpatient clinic, regular use of a spacer during inhalation), the final regression model showed that ethnicity was independently associated with adherence (p = 0.028).
  
  
  CONCLUSIONS
  In our Western European population of inner city children with asthma, poor adherence to ICS was a serious problem, and even somewhat more so in ethnic minorities. Paediatricians involved in asthma treatment should be aware of these cultural differences in medication-taking behaviour, but further studies are needed to elucidate the causal mechanism.
authors.affiliation: Department of Hospital Pharmacy, Erasmus Medical Center, Room L-030, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Vasbinder
authors.forename: Nordin
authors.initials: N
authors.lastname: Dahhan
authors.forename: Bart
authors.initials: B
authors.lastname: Wolf
authors.forename: Jan
authors.initials: J
authors.lastname: Zoer
authors.forename: Ellen
authors.initials: E
authors.lastname: Blankman
authors.forename: Diederik
authors.initials: D
authors.lastname: Bosman
authors.forename: Liset
authors.initials: L
authors.lastname: van Dijk
authors.forename: Patricia
authors.initials: P
authors.lastname: van den Bemt
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology; D044383:Black People / Q000706:statistics & numerical data*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003466:Cultural Characteristics; D004867:Equipment Design; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D036501:Metered Dose Inhalers; D009018:Morocco / Q000453:epidemiology; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014504:Urban Health; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents