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Social Determinants of Health and Medication Adherence in Older Adults with Prevalent Health Conditions in the United States: An analysis of the National Health and Nutrition Examination Survey (NHANES) 2009-2018

Year: 2024

Type: preprint

Abstract: Background The older adult population is rapidly expanding in the United States (US), with high blood pressure, high cholesterol, and diabetes ranking among the top health conditions for older adults. Medication nonadherence, not taking medications as prescribed, is prevalent among those managing multiple chronic conditions. Despite its complexity, evidence is lacking on the social determinants of health (SDOH) influencing medication adherence among older adults with high blood pressure, high cholesterol, and/or diabetes in the US. Thus, the primary objective of this study was to identify and prioritize SDOH associated with medication adherence among a nationally representative sample of US older adults with high blood pressure, high cholesterol, and/or diabetes. Methods Using the World Health Organization Commission on Social Determinants of Health and Pharmacy Quality Alliance Medication Access Conceptual Frameworks, publicly available National Health and Nutrition Examination Survey datasets (2009–2018) were cross-sectionally analyzed among respondents aged 65 and older with study diseases. Respondents reporting taking their study disease state medication(s) were considered adherent. Data analysis included descriptive statistics, Rao-Scott Chi-Square tests, and logistic regression analyses. Highly correlated predictors were removed to address multicollinearity, and the rest were consolidated into a single variable. The study used a significance level of 0.05. Results Analyses included 5,513 respondents' data. Univariate analysis showed that several structural (gender, p = .009; ethnicity, p = .038; social class, p = .023) and intermediary (e.g., level of alcohol consumption, p = .004; disability status, p = .014; affordability of household balanced meals, p < .001) determinants of health were significantly associated with medication adherence. Multivariable analysis revealed significant differences in medication adherence for alcohol consumption (p = .034) and usual place for healthcare (p = .001). For instance, individuals who usually go to a doctor’s office or health maintenance organization have 330% higher odds of adhering to medications than those with no usual place for healthcare (p = .002). Conclusions Study findings underscore pertinent implications for public health and policy, prioritizing specific SDOH most likely to affect medication adherence in common chronic conditions among older adults in the US. Strikingly, the observed relationship between alcohol consumption trends and adherence is a distinct finding warranting further investigation.

Source: Research Square

DOI: 10.21203/rs.3.rs-3872074/v1

Authors: Omolola A. Adeoye-Olatunde, Tessa J. Hastings, Michelle L. Blakely, LaKeisha Boyd, Azeez B. Aina, Fatimah Sherbeny