title: A National Assessment of Medication Adherence to Statins by the Racial Composition of Neighborhoods.
abstract: Adherence to statins is lower in black and Hispanic patients and is linked to racial/ethnic disparities in cardiovascular mortality. Poverty, education, and prescription coverage differentials are typically invoked to explain adherence disparities, but analyses at the level of neighborhoods and their pharmacies may provide additional insights. Among individuals filling new statin prescriptions in a national pharmacy chain (N = 326,171), we compared adherence for patients residing in mostly minority neighborhoods to those living in mainly white areas. In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in black and Hispanic neighborhoods had 2-3 weeks less statin therapy over 1 year, a pattern not seen in Asian areas. In black and Hispanic neighborhoods, good adherence was associated with co-pays under $10, the use of 90-day refills, and payers other than Medicaid. Efforts to improve medication adherence for vulnerable populations may benefit from interventions at the level of local pharmacies, as well as medication benefit redesign.
authors.affiliation: Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA. amd@uchicago.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Clinical Outcomes and Analytic Services, Walgreen Co, Deerfield, IL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Taitel
authors.affiliation: Clinical Outcomes and Analytic Services, Walgreen Co, Deerfield, IL, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy Systems, Outcomes, and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA.
authors.forename: Dima M
authors.initials: DM
authors.lastname: Qato
authors.affiliation: Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Peek
authors.affiliation: Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chou
authors.affiliation: Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA.
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
mesh_terms: D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Medication adherence; Neighborhood; Pharmacies; Racial and ethnic disparities; Statin therapy