TY - JOUR
T1 - AssociAtion of perceived stress and discrimination on medication adherence among diverse patients with uncontrolled hypertension
AU - RICH LIFE Project Investigators
AU - Alvarez, Carmen
AU - Hines, Anika L.
AU - Carson, Kathryn A.
AU - Andrade, Nadia
AU - Ibe, Chidinma A.
AU - Marsteller, Jill A.
AU - Cooper, Lisa A.
AU - Ahima, Rexford
AU - Antoine, Denis G.
AU - Avornu, Gideon
AU - Bhattarai, Jagriti
AU - Bone, Lee
AU - Boonyasai, Romsai T.
AU - Charleston, Jeanne
AU - Chung, Suna
AU - Cort, Marcia
AU - Crews, Deidra C.
AU - Daumit, Gail L.
AU - Dietz, Katherine B.
AU - Eyer, Teresa
AU - Frazier, Demetrius
AU - Greer, Raquel
AU - Hickman, Debra
AU - Hill-Briggs, Felicia
AU - Dennison-Himmelfarb, Cheryl R.
AU - Hull, Tammie
AU - Johnson, Lawrence
AU - Johnson, Susan
AU - Kargbo, Mary
AU - Kelleher, Mary
AU - Lazo, Mariana
AU - Lubomski, Lisa
AU - Mathews, Lena M.
AU - Miller, Edgar R.
AU - Ndumele, Chiadi E.
AU - Turk-Son-Ocran, Ruth Alma
AU - Parker, Randy
AU - Peterson, Cassandra
AU - Purnell, Tanjala S.
AU - Spicyn, Natalie
AU - Teagle, De Notta
AU - Wang, Nae Yuh
AU - White, Marcee
AU - Yeh, Hsin Chieh
AU - Young, Joan
AU - Zeren, Kimberly L.
N1 - Funding Information:
This work was supported by a grant from the National Heart, Lung, and Blood Institute through a partnerships with the Patient-Centered Outcomes Research Institute (UH2/UH3 HL130688).
Publisher Copyright:
© 2021 Ethnicity and Disease, Inc.. All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Background: Uncontrolled hypertension is a significant risk factor for cardiovascular morbidity and mortality. In the United States, many patients remain uncontrolled, in part, due to poor medication adherence. Efforts to improve hypertension control include not only attending to medical management of the disease but also the social determinants of health, which impact medication adherence, and ultimately blood pressure control. Purpose: To determine which social determinants – health care access or community and social stressors - explain medication adherence. Methods: In this cross-sectional analysis, we used baseline data (N=1820, collected August 2017 to October 2019) from a pragmatic trial, which compares the effectiveness of a multi-level intervention including collaborative care and a stepped approach with enhanced standard of care for improving blood pressure. We used logistic regression analyses to examine the association between patient experiences of care and community and social stressors with medication adherence. Results: The participants represented a diverse sample: mean age of 60 years; 59% female; 57.3% Black, 9.6% Hispanic, and 33.2% White. All participants had a blood pressure reading ≥140/90 mm Hg (mean blood pressure – 152/85 mm Hg). Half of the participants reported some level of non-adherence to medication. Regression analysis showed that, compared with Whites, Blacks (AOR .47; 95% CIs: .37-.60, P<.001) and Hispanics (AOR .48; 95% CIs: .32- .73, P<.001) were less likely to report medication adherence. Also part-time workers (AOR .57; 95% CIs: .38-.86, P<.05), and those who reported greater perceived stress (AOR .94; 95% CIs: .91 – .98, P<.001) and everyday discrimination (AOR .73; 95% CIs: .59 – .89; P<.001) had lower odds of medication adherence. Among Blacks, greater perceived stress (AOR .93; 95% CIs: .88-.98, P<.001) and everyday discrimination (AOR .63; 95% CIs: .49 - .82, P<.005) were negatively associated with medication adherence. Among Hispanics, greater report of everyday discrimination (AOR .36; 95% CIs: .14 – .89, P<.005) was associated with lower odds of medication adherence. Among Whites, the negative effect of perceived stress on medication adherence was attenuated by emotional support. Conclusions: Using the social determinants of health framework, we identified associations between stress, everyday discrimination and medication adherence among non-Hispanic Blacks and Hispanics that were independent of health status and other social determinants. Programs to enhance self-management for African American and Hispanic patients with uncontrolled blood pressure should include a specific focus on addressing social stressors.
AB - Background: Uncontrolled hypertension is a significant risk factor for cardiovascular morbidity and mortality. In the United States, many patients remain uncontrolled, in part, due to poor medication adherence. Efforts to improve hypertension control include not only attending to medical management of the disease but also the social determinants of health, which impact medication adherence, and ultimately blood pressure control. Purpose: To determine which social determinants – health care access or community and social stressors - explain medication adherence. Methods: In this cross-sectional analysis, we used baseline data (N=1820, collected August 2017 to October 2019) from a pragmatic trial, which compares the effectiveness of a multi-level intervention including collaborative care and a stepped approach with enhanced standard of care for improving blood pressure. We used logistic regression analyses to examine the association between patient experiences of care and community and social stressors with medication adherence. Results: The participants represented a diverse sample: mean age of 60 years; 59% female; 57.3% Black, 9.6% Hispanic, and 33.2% White. All participants had a blood pressure reading ≥140/90 mm Hg (mean blood pressure – 152/85 mm Hg). Half of the participants reported some level of non-adherence to medication. Regression analysis showed that, compared with Whites, Blacks (AOR .47; 95% CIs: .37-.60, P<.001) and Hispanics (AOR .48; 95% CIs: .32- .73, P<.001) were less likely to report medication adherence. Also part-time workers (AOR .57; 95% CIs: .38-.86, P<.05), and those who reported greater perceived stress (AOR .94; 95% CIs: .91 – .98, P<.001) and everyday discrimination (AOR .73; 95% CIs: .59 – .89; P<.001) had lower odds of medication adherence. Among Blacks, greater perceived stress (AOR .93; 95% CIs: .88-.98, P<.001) and everyday discrimination (AOR .63; 95% CIs: .49 - .82, P<.005) were negatively associated with medication adherence. Among Hispanics, greater report of everyday discrimination (AOR .36; 95% CIs: .14 – .89, P<.005) was associated with lower odds of medication adherence. Among Whites, the negative effect of perceived stress on medication adherence was attenuated by emotional support. Conclusions: Using the social determinants of health framework, we identified associations between stress, everyday discrimination and medication adherence among non-Hispanic Blacks and Hispanics that were independent of health status and other social determinants. Programs to enhance self-management for African American and Hispanic patients with uncontrolled blood pressure should include a specific focus on addressing social stressors.
KW - Discrimination
KW - Hypertension
KW - Medication Adherence
KW - Social Determinants
KW - Stress
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U2 - 10.18865/ED.31.1.97
DO - 10.18865/ED.31.1.97
M3 - Article
C2 - 33519160
AN - SCOPUS:85100683665
SN - 1049-510X
VL - 31
SP - 97
EP - 108
JO - Ethnicity and Disease
JF - Ethnicity and Disease
IS - 1
ER -