Sex-based disparities with cost-related medication adherence issues in patients with hypertension, ischemic heart disease, and heart failure.

IF 4.7 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS
Ivann Agapito, Tu Hoang, Michael Sayer, Ali Naqvi, Pranav M Patel, Aya F Ozaki
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引用次数: 0

Abstract

Importance and objective: Identifying sources of sex-based disparities is the first step in improving clinical outcomes for female patients. Using All of Us data, we examined the association of biological sex with cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities.

Materials and methods: Retrospective data collection identified the following patients: 18 and older, completing personal medical history surveys, having hypertension (HTN), ischemic heart disease (IHD), or heart failure (HF) with medication use history consistent with these diagnoses. Implementing univariable and adjusted logistic regression, we assessed the influence of biological sex on 7 different patient-reported CRMA outcomes within HTN, IHD, and HF patients.

Results: Our study created cohorts of HTN (n = 3891), IHD (n = 5373), and HF (n = 2151) patients having CRMA outcomes data. Within each cohort, females were significantly more likely to report various cost-related medication issues: being unable to afford medications (HTN hazards ratio [HR]: 1.68, confidence interval [CI]: 1.33-2.13; IHD HR: 2.33, CI: 1.72-3.16; HF HR: 1.82, CI: 1.22-2.71), skipping doses (HTN HR: 1.76, CI: 1.30-2.39; IHD HR: 2.37, CI: 1.69-3.64; HF HR: 3.15, CI: 1.87-5.31), taking less medication (HTN HR: 1.86, CI: 1.37-2.45; IHD HR: 2.22, CI: 1.53-3.22; HF HR: 2.99, CI: 1.78-5.02), delaying filling prescriptions (HTN HR: 1.83, CI: 1.43-2.39; IHD HR: 2.02, CI: 1.48-2.77; HF HR: 2.99, CI: 1.79-5.03), and asking for lower cost medications (HTN HR: 1.41, CI: 1.16-1.72; IHD HR: 1.75, CI: 1.37-2.22; HF HR: 1.61, CI: 1.14-2.27).

Discussion and conclusion: Our results clearly demonstrate CRMA issues disproportionately affect female patients with cardiovascular comorbidities, which may contribute to the larger sex-based disparities in cardiovascular care. These findings call for targeted interventions and strategies to address these disparities and ensure equitable access to cardiovascular medications and care for all patients.

高血压、缺血性心脏病和心力衰竭患者在坚持服药方面与成本相关的性别差异。
重要性和目的:确定性别差异的根源是改善女性患者临床治疗效果的第一步。利用 "我们所有人 "的数据,我们研究了心血管合并症患者的生理性别与成本相关用药依从性(CRMA)问题的关联:回顾性数据收集确定了以下患者:18岁及以上,完成个人病史调查,患有高血压(HTN)、缺血性心脏病(IHD)或心力衰竭(HF),且用药史与这些诊断一致。通过单变量和调整后的逻辑回归,我们评估了生理性别对高血压、缺血性心脏病和心力衰竭患者的 7 种不同的患者报告 CRMA 结果的影响:我们的研究建立了具有 CRMA 结果数据的高血压、心肌缺血和高血脂患者队列,分别为 3891 人、5373 人和 2151 人。在每个队列中,女性更有可能报告各种与费用相关的用药问题:无法负担药物费用(高血压危险比 [HR]:1.68,置信区间 [CR]:1.68,置信区间 [CR]:1.68):1.68,置信区间 [CI]:1.33-2.13;IHD HR:2.33,CI:1.72-3.16;HF HR:1.82,CI:1.22-2.71)、漏服药(HTN HR:1.76,CI:1.30-2.39;IHD HR:2.37,CI:1.69-3.02)、延迟开处方(高血压 HR:1.83,CI:1.43-2.39;高血脂 HR:2.02,CI:1.48-2.77;高血脂 HR:2.99,CI:1.79-5.03)、要求低价药物(高血压 HR:1.41,CI:1.16-1.72;高血脂 HR:1.75,CI:1.37-2.22;高血脂 HR:1.61,CI:1.14-2.27):我们的研究结果清楚地表明,CRMA 问题对患有心血管合并症的女性患者的影响尤为严重,这可能会导致心血管护理中更大的性别差异。这些发现要求采取有针对性的干预措施和策略来解决这些差异,并确保所有患者都能公平地获得心血管药物和护理。
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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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