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Exploring the Relationship Between Medication Adherence and Diabetes Disparities among Hispanic Patients in a Large
Kimberly Danae Cauley Narain1,2, Ayan Patel3, Samuel Skootsky4,5
1Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. KNarain@mednet.ucla.edu.
Insights
Medication adherence did not explain the higher HbA1c levels in Hispanic patients compared to other groups. Further research is needed to understand factors beyond medication adherence impacting diabetes control in this population.
Area of Science:
- Diabetes Management
- Health Disparities Research
- Clinical Informatics
Background:
- Sub-optimal hemoglobin A1c (HbA1c) control contributes to disparities in diabetes outcomes for Hispanic patients.
- Differences in medication adherence are a potential factor contributing to racial/ethnic variations in HbA1c levels.
Purpose of the Study:
- To investigate the association between medication adherence and disparities in HbA1c levels among Hispanic patients compared to other racial/ethnic groups within the University of California Health System (UC Health).
Main Methods:
- A cross-sectional analysis utilized clinical, administrative, and prescription dispensing data from UC Health electronic health records (January-December 2021).
- Linear regression models (LRMs) assessed the relationship between medication adherence (proportion of days covered - PDC) and HbA1c levels, adjusting for race/ethnicity.
- The study included 27,542 patients aged 18-75, reporting Asian, Hispanic, or White race/ethnicity, with a diabetes diagnosis or medication prescription.
Main Results:
- In models excluding medication adherence, Hispanic ethnicity showed a positive association with HbA1c levels (β=0.31, p<0.001).
- When medication adherence (PDC) was included, it was negatively associated with HbA1c levels (β=-0.18, p<0.001).
- Crucially, the positive association between Hispanic ethnicity and HbA1c levels remained unchanged (β=0.31, p<0.001), indicating adherence did not explain the disparity.
Conclusions:
- Medication adherence, measured by PDC, did not account for the observed disparities in HbA1c levels among Hispanic patients.
- These findings highlight the need to explore other factors beyond medication adherence that influence the relationship between Hispanic ethnicity and HbA1c levels in academic medical centers.
Background:
Sub-optimal HbA1c control is a driver of disparities in diabetes outcomes among Hispanic patients. Differences in medication adherence may underlie racial/ethnic differences in HbA1c level.
Objective:
To examine the relationship between medication adherence and disparities in HbA1c level among Hispanic patients, relative to other racial/ethnic groups, obtaining care in the University of California Health System (UC Health).
Design:
This study used clinical, administrative, and prescription dispensing data (January-December 2021) derived from the electronic health records of 5 Academic Medical Centers in UC Health, and linear regression models (LRMs) to conduct a cross-sectional analysis of the association between medication adherence, race/ethnicity, and HbA1c level. Adjusted LRMs were run with and without the measure of medication adherence to assess this relationship.
Participants:
Patients with a UC Health primary care physician (PCP), with ≥ 1 PCP visit within the last 3 years, ages 18-75, reporting Asian, Hispanic, or White race/ethnicity, and who had ≥ 2 encounters with an ICD diagnosis of diabetes or had a prescription for a diabetes medication within the last 2 years, as of 12/31/21 (N = 27, 542; Asian = 6253, Hispanic = 7216, White = 14,073).
Main Measures:
Our measure of medication adherence was the proportion of days covered (PDC) for diabetes medications in 2021. Our outcome was the most recent HbA1c value.
Key Results:
In the LRM excluding the PDC, Hispanic ethnicity was positively associated with HbA1c level (β = 0.31, p = < 0.001). In the LRM model including PDC, PDC was negatively associated with HbA1c level (β = - 0.18, p = < 0.001). However, the positive relationship between Hispanic ethnicity and HbA1c level did not change (β = 0.31, p = < 0.001).
Conclusions:
The findings of this study suggest that the relationship between Hispanic ethnicity, HbA1c level, and factors outside of medication adherence should be explored among primary care patients receiving care in Academic Medical Centers.
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