Region of Birth Differences in Medication Adherence among Patients with Stroke or Transient Ischemic Attack

Cultural and language barriers may affect quality of care, such as adherence to medications. We examined whether adherence to prevention medications within the year after stroke/transient ischemic attack (TIA) differed by the region of birth.

An observational study of adults with stroke/TIA admitted to hospitals in the Australian Stroke Clinical Registry (Queensland, Victoria; 2012-2016; n = 45 hospitals). Data from the registry were linked with administrative data. Region of birth was categorized into 10 groups (Australia, Other Oceania, North-West Europe, Southern/Eastern Europe, North Africa/Middle East, South-East Asia, North-East Asia, Southern/Central Asia, Americas, Sub-Saharan Africa). Analysis was limited to those with a first-ever stroke/TIA who were dispensed an antihypertensive, lipid-lowering, or antithrombotic medication within 1-year post-discharge. Medication adherence was calculated based on the proportion of days covered until 1-year immediately post-discharge/death. Associations between region of birth and being adherent (PDC ≥80%) were determined using multivariable logistic regression (adjusted for age, sex, stroke type, ability to walk on admission, discharge destination, socioeconomic position, main language spoken, comorbidity score).

Among 24,236 eligible participants (median age 74 years, 44% female, 68% Australian-born), 54% were adherent to antihypertensive medications, 56% to lipid-lowering medications, and 49% to antithrombotic medications. Compared to Australian-born participants, those born in Other Oceania (4.0%) were less likely to be adherent to lipid-lowering medications (odds ratio [OR] 0.78, 95% CI: 0.67-0.90) and antithrombotic (OR 0.84, 95% CI: 0.72-0.97). Compared to Australian-born participants, those born in Southern and Central Asia (1.4%) were less likely to be adherent to lipid-lowering medications (OR: 0.76, 95% CI: 0.58-0.99) and antithrombotic (0.55, 95% CI: 0.40-0.76). No significant differences were found with other regions.

Disparities by the region of birth were observed in medication adherence after stroke/TIA for participants born in Asia and Oceania. Targeted education to improve medication adherence, specific to the needs of these groups, is warranted.