Access to Care, Treatment Ambivalence, Medication Nonadherence, and Long-Term Mortality Among Severely Hypertensive African Americans: A Prospective Cohort Study

Research output: Contribution to journalArticle

Abstract

African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow-up of 6.1 years. Patients with pill-taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95% CI, 1.88-9.03). Pill-taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95% CI, 1.39-6.32), side effects (OR, 3.44; 95% CI, 1.47-8.03), forgetfulness (OR, 3.62; 95% CI, 1.78-7.34), and feeling that the medications do not help (OR, 2.78; 95% CI, 1.09-7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.

Original languageEnglish (US)
Pages (from-to)614-621
Number of pages8
JournalJournal of clinical hypertension (Greenwich, Conn.)
Volume17
Issue number8
DOIs
StatePublished - Aug 1 2015

Fingerprint

Medication Adherence
African Americans
Cohort Studies
Prospective Studies
Confidence Intervals
Odds Ratio
Mortality
Hypertension
Therapeutics
Cost of Illness
Prescriptions
Emotions
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

@article{bd2ef52526a547319be2c2dd9e8e484e,
title = "Access to Care, Treatment Ambivalence, Medication Nonadherence, and Long-Term Mortality Among Severely Hypertensive African Americans: A Prospective Cohort Study",
abstract = "African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6{\%} over a median follow-up of 6.1 years. Patients with pill-taking nonadherence were more likely to die (hazard ratio, 1.80; 95{\%} confidence interval [CI], 1.18-2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95{\%} CI, 1.88-9.03). Pill-taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95{\%} CI, 1.39-6.32), side effects (OR, 3.44; 95{\%} CI, 1.47-8.03), forgetfulness (OR, 3.62; 95{\%} CI, 1.78-7.34), and feeling that the medications do not help (OR, 2.78; 95{\%} CI, 1.09-7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.",
author = "Young, {J Hunter} and Derek Ng and Chidinma Ibe and Kristina Weeks and Daniel Brotman and Dy, {Sydney E} and Brancati, {Frederick L.} and David Levine and Klag, {Michael John}",
year = "2015",
month = "8",
day = "1",
doi = "10.1111/jch.12562",
language = "English (US)",
volume = "17",
pages = "614--621",
journal = "Journal of clinical hypertension",
issn = "0895-7061",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Access to Care, Treatment Ambivalence, Medication Nonadherence, and Long-Term Mortality Among Severely Hypertensive African Americans

T2 - A Prospective Cohort Study

AU - Young, J Hunter

AU - Ng, Derek

AU - Ibe, Chidinma

AU - Weeks, Kristina

AU - Brotman, Daniel

AU - Dy, Sydney E

AU - Brancati, Frederick L.

AU - Levine, David

AU - Klag, Michael John

PY - 2015/8/1

Y1 - 2015/8/1

N2 - African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow-up of 6.1 years. Patients with pill-taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95% CI, 1.88-9.03). Pill-taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95% CI, 1.39-6.32), side effects (OR, 3.44; 95% CI, 1.47-8.03), forgetfulness (OR, 3.62; 95% CI, 1.78-7.34), and feeling that the medications do not help (OR, 2.78; 95% CI, 1.09-7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.

AB - African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow-up of 6.1 years. Patients with pill-taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95% CI, 1.88-9.03). Pill-taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95% CI, 1.39-6.32), side effects (OR, 3.44; 95% CI, 1.47-8.03), forgetfulness (OR, 3.62; 95% CI, 1.78-7.34), and feeling that the medications do not help (OR, 2.78; 95% CI, 1.09-7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.

UR - http://www.scopus.com/inward/record.url?scp=84937513208&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937513208&partnerID=8YFLogxK

U2 - 10.1111/jch.12562

DO - 10.1111/jch.12562

M3 - Article

C2 - 25923581

AN - SCOPUS:84937513208

VL - 17

SP - 614

EP - 621

JO - Journal of clinical hypertension

JF - Journal of clinical hypertension

SN - 0895-7061

IS - 8

ER -