While these results might not be surprising, the findings might help develop ways to better address barriers for patients prescribed the lifesaving drugs, according to researchers at New York University (NYU) Grossman School of Medicine and colleagues.
“Medication nonadherence is common among patients with HFrEF and can lead to increased hospitalization and mortality,” the researchers wrote in the Journal of the American Medical Association Network Open. “Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies.”
To study team sought to examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density.
To do that, researchers conducted a retrospective cohort study between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. The study included adult patients with a diagnosis of HFrEF on echocardiogram, and a prescription of at least one guideline-directed medical therapy (GDMT) for HFrEF.
The Agency for Healthcare Research and Quality SES (socioeconomic status) index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, was used to calculate nSES after patient addresses were geocoded.
The researchers obtained medication nonadherence by linking health record prescription data with pharmacy fill data; it was defined as the proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications.
The 6,247 participants had a mean age of 73 years and were 69.5% male. Most (62.9%) were white, with 16.2% black participants and 11.8% Hispanic/Latinx participants.
The results indicated that patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1,086 participants) to 40.0% in the highest quartile (563 of 1,086 participants; P <.001). “In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]),” the authors pointed out. “No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed.”
“Our findings highlight the importance of considering neighborhood socioeconomic status when developing interventions to ensure people with heart failure have access to their medications,” explained study lead author, cardiologist Amrita Mukhopadhyay, MD, of NYU Langone Health, in a press release.
Coauthor Saul Blecker, MD, an associate professor in the Departments of Population Health and Medicine at NYU Langone Health, said the results “support targeting interventions that have already been shown to improve medication adherence, such as patient education programs and frequent follow-up with healthcare professionals, for those living in the most at-risk areas.”
Dr. Blecker cautioned, however, that it is not yet known what specific factors are most responsible for that gap. Neither access to transportation nor the density of pharmacies in the area appeared to play a large role, he advised.
But other factors could be at play. “Now that we have uncovered this disparity at a neighborhood level, we next need to explore additional barriers patients may be facing, such as the cost of drugs, language barriers, and discrimination by pharmacy staff,” said study senior author Samrachana Adhikari, PhD.
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