Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South.
OBJECTIVE
Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States.


METHODS
Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP.


RESULTS
Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP.


CONCLUSIONS
Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities.
Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, and School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Doyle M
DM
Cummings
School of Nursing, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Jia-Rong
JR
Wu
Department of General Internal Medicine, School of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Crystal
C
Cene
Department of Family Medicine, School of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Jacquie
J
Halladay
Department of Family Medicine, School of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Katrina E
KE
Donahue
Division of Cardiology, School of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Alan
A
Hinderliter
Center for Health Promotion/Disease Prevention, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Cassandra
C
Miller
Center for Health Promotion/Disease Prevention, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Beverly
B
Garcia
Department of Social Medicine, School of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
Dolly
D
Penn
Community Care Plan of Eastern Carolina, Greenville, North Carolina.
Jim
J
Tillman
CMS Innovation Center, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Darren
D
DeWalt
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data
D000959:Antihypertensive Agents
health disparities; health services research; hypertension; medication adherence; social determinants of health