title: Patterns and predictors of medication adherence to lipid-lowering therapy in children aged 8 to 20 years.
abstract: The American Academy of Pediatrics recommends lipid-lowering therapy (LLT) for children at high risk of cardiovascular disease. However, the use of LLT in children is rare, and rates of nonadherence are unknown.
  
  
  
  To identify patterns of use and predictors of nonadherence to LLT in children aged 8 to 20 years and the subgroup with dyslipidemia.
  
  
  
  Commercially insured patients with a new dispensing for an LLT were included. Nonadherence was defined as a gap of >90 days between the last dispensing plus the medication days supply and the next dispensing or censoring. Descriptive statistics characterize the patterns of LLT adherence and class-specific drug switching. Kaplan-Meier curves and multivariable Cox proportional hazard models identified time to, and predictors of, nonadherence for the cohort and the dyslipidemia subgroup.
  
  
  
  Of the 8710 patients meeting inclusion criteria, 87% were nonadherent. Statins were the most common index prescription, and patients with an index statin dispensing were more likely to have multiple comorbidities and other prescription drug use. In multivariable analyses, nonadherence was inversely associated with dyslipidemia (hazard ratio [HR] = 0.61, 95% confidence interval [CI] = 0.57-0.65), chronic kidney disease (HR = 0.69, 95% CI = 0.54-0.88), higher outpatient (HR = 0.87, 95% CI = 0.77-0.98), and inpatient (HR = 0.83, 95% CI = 0.70-0.97) use. When limited to patients with dyslipidemia, nonadherence was related to age (HR = 1.21, 95% CI = 1.07-1.38) and obesity (HR = 1.23, 95% CI = 1.02-1.49).
  
  
  
  Despite recommendations to begin continuous treatment early for high-risk children, nonadherence to LLT is frequent in this population, with modestly higher adherence in children with dyslipidemia.
authors: Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. Electronic address: Joyce@hcp.harvard.med.edu.
authors: Nina R
authors: NR
authors: Joyce
authors: Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
authors: Gregory A
authors: GA
authors: Wellenius
authors: Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
authors: Charles B
authors: CB
authors: Eaton
authors: Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA.
authors: Amal N
authors: AN
authors: Trivedi
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors: Justin P
authors: JP
authors: Zachariah
mesh_terms: D000293:Adolescent; D002648:Child; D016208:Databases, Factual; D050171:Dyslipidemias / Q000188:drug therapy; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use*; D007348:Insurance, Health; D008297:Male; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000960:Hypolipidemic Agents
keywords: Dyslipidemia; Medication adherence; Pediatrics; Pharmacoepidemiology