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Sex-based disparities with cost-related medication adherence issues in patients with hypertension, ischemic heart
Ivann Agapito1, Tu Hoang1, Michael Sayer1
1School of Pharmacy & Pharmaceutical Sciences, Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, CA 92697, United States.
Insights
Female patients with cardiovascular conditions experience higher rates of cost-related medication adherence issues, including affording, skipping, and altering doses. These findings highlight a significant disparity contributing to poorer cardiovascular care outcomes for women.
Area of Science:
- Cardiology
- Health Services Research
- Pharmacoeconomics
Background:
- Sex-based disparities in clinical outcomes are a significant concern in cardiovascular medicine.
- Understanding the factors contributing to these disparities is crucial for improving patient care.
Purpose of the Study:
- To investigate the association between biological sex and cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities.
- To identify specific CRMA challenges faced by female patients with hypertension, ischemic heart disease, and heart failure.
Main Methods:
- Retrospective analysis of the All of Us research program data.
- Inclusion of adult patients (18+) with hypertension, ischemic heart disease, or heart failure and medication history.
- Utilized univariable and adjusted logistic regression to assess the influence of biological sex on CRMA outcomes.
Main Results:
- Female patients with hypertension, ischemic heart disease, and heart failure were significantly more likely to report CRMA issues.
- Specific issues included inability to afford medications, skipping doses, taking less medication, delaying prescription refills, and requesting lower-cost alternatives.
- Hazard ratios for these issues were consistently higher for females across all studied cardiovascular conditions.
Conclusions:
- Cost-related medication adherence issues disproportionately affect female patients with cardiovascular comorbidities.
- These disparities in medication access and adherence may exacerbate sex-based differences in cardiovascular care.
- Targeted interventions are needed to address these CRMA issues and promote equitable cardiovascular care for all patients.
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.
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