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The Role of the Social Determinants of Health Factors on the Access, Adherence and Effectiveness of Prescribed Medications

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 8902

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Special Issue Editors

Dr. Macarius M. Donneyong

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Guest Editor

College of Public Health, The Ohio State University, Columbus, OH 43210, USA
Interests: pharmacoepidemiology; adherence, safety and effectiveness of prescribed medications; social determinants of health; health disparities

Dr. David Kline

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Assistant Guest Editor

Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
Interests: biostatistics; population health; spatio-temporal epidemiology; Bayesian methods; small area estimation; disease mapping; epidemiologic methods

Prof. Dr. Daniel F. Sarpong

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Assistant Guest Editor

Center for Minority Health & Health Disparities Research & Education, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA
Interests: public exposome; built environment; health disparities; statistical modeling; epidemiological studies; chronic diseases; infectious diseases; social determinants; biological determinants
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The structural determinants and conditions in which people are born, grow, live, work and age, referred to as the social and structural determinants of health (SDH), are known determinants of several chronic disease conditions. Most chronic disease patients require long-term treatment with prescribed medications. Emerging research suggests that SDH play an important role in determining the effectiveness of prescribed medications, especially among socioeconomically disadvantaged populations. The mechanisms by which SDH influence therapeutic response have not been well investigated, but it has been posited that SDH may influence therapeutic response via intermediary determinants of medication effectiveness, namely, (1) access and quality of treatment with medications; and (2) adherence to medications. To date, these hypotheses have not been adequately investigated in the literature or tested with empirical data. This Special Issue, therefore, invites manuscripts that present empirical data on the role of SDH in the effectiveness of prescribed medications and intermediary outcomes (access to quality treatment with medications and adherence), as well as reviews and meta-analysis of published studies on this topic.

Dr. Macarius M. Donneyong
Dr. David Kline
Prof. Dr. Daniel F. Sarpong
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pharmacoepidemiology
adherence, safety and effectiveness of prescribed medications
social determinants of health
real-world data

Published Papers (3 papers)

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Research

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15 pages, 1758 KiB

Open AccessArticle

Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis

by Macarius M. Donneyong, Michael A. Fischer, Michael A. Langston, Joshua J. Joseph, Paul D. Juarez, Ping Zhang and David M. Kline

Int. J. Environ. Res. Public Health 2021, 18(23), 12702; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312702 - 02 Dec 2021

Cited by 1 | Viewed by 2203

Abstract

Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke. Full article

(This article belongs to the Special Issue The Role of the Social Determinants of Health Factors on the Access, Adherence and Effectiveness of Prescribed Medications)

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12 pages, 1366 KiB

Open AccessArticle

Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment

by Macarius M. Donneyong, Teng-Jen Chang, John W. Jackson, Michael A. Langston, Paul D. Juarez, Shawnita Sealy-Jefferson, Bo Lu, Wansoo Im, R. Burciaga Valdez, Baldwin M. Way, Cynthia Colen, Michael A. Fischer, Pamela Salsberry, John F.P. Bridges and Darryl B. Hood

Int. J. Environ. Res. Public Health 2020, 17(18), 6684; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186684 - 14 Sep 2020

Cited by 14 | Viewed by 3919

Abstract

Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R² = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments. Full article

(This article belongs to the Special Issue The Role of the Social Determinants of Health Factors on the Access, Adherence and Effectiveness of Prescribed Medications)

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Review

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23 pages, 2686 KiB

Open AccessReview

Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions

by Vicente F. Gil-Guillen, Alejandro Balsa, Beatriz Bernárdez, Carmen Valdés y Llorca, Emilio Márquez-Contreras, Juan de la Haba-Rodríguez, Jose M. Castellano and Jesús Gómez-Martínez

Int. J. Environ. Res. Public Health 2022, 19(19), 12036; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912036 - 23 Sep 2022

Cited by 3 | Viewed by 2158

Abstract

Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project’s objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors’ level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors’ opinion. Information and education are essential to improve adherence in all patients. Full article

(This article belongs to the Special Issue The Role of the Social Determinants of Health Factors on the Access, Adherence and Effectiveness of Prescribed Medications)

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