Medication Nonadherence After Lung Transplantation in Adult Recipients.
BACKGROUND
Our objective was to identify potential avenues for resource allocation and patient advocacy to improve outcomes by evaluating the association between recipient sociodemographic and patient characteristics and medication nonadherence after lung transplantation.


METHODS
States US adult, lung-only transplantations per the United Network for Organ Sharing database were analyzed from October 1996 through December 2006, based on the period during which nonadherence information was recorded. Generalized linear models were used to determine the association of demographic, disease, and transplantation center characteristics with early nonadherence (defined as within the first year after transplantation) as well as late nonadherence (years 2 to 4 after transplantation). Outcomes comparing adherent and nonadherent patients were also evaluated.


RESULTS
Patients (n = 7,284) were included for analysis. Early and late nonadherence rates were 3.1% and 10.6%, respectively. Factors associated with early nonadherence were Medicaid insurance compared with private insurance (adjusted odds ratio [AOR] 2.45, 95% confidence interval [CI]: 1.16 to 5.15), and black race (AOR 2.38, 95% CI: 1.08 to 5.25). Medicaid insurance and black race were also associated with late nonadherence (AOR 2.38, 95% CI: 1.51 to 3.73 and OR 1.73, 95% CI: 1.04 to 2.89, respectively), as were age 18 to 20 years (AOR 3.41, 95% CI: 1.29 to 8.99) and grade school or lower education (AOR 1.88, 95% CI: 1.05 to 3.35). Early and late nonadherence were both associated with significantly shorter unadjusted survival (p < 0.001).


CONCLUSIONS
Identifying patients at risk of nonadherence may enable resource allocation and patient advocacy to improve outcomes.
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: anthony.castleberry@duke.edu.
Anthony W
AW
Castleberry
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Muath
M
Bishawi
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
Mathias
M
Worni
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Loretta
L
Erhunmwunsee
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Paul J
PJ
Speicher
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Asishana A
AA
Osho
Division of Pulmonary and Critical Care, Duke University Medical Center, Durham, North Carolina.
Laurie D
LD
Snyder
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Matthew G
MG
Hartwig
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D006278:Medicare; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D066027:Transplant Recipients; D014481:United States; D055815:Young Adult