Skip to main content

Advertisement

SpringerLink
Log in

Differential Impact of Longitudinal Medication Non-Adherence on Mortality by Race/Ethnicity among Veterans with Diabetes

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

OBJECTIVE

To examine the differential effect of medication non-adherence over time on all-cause mortality by race/ethnicity.

RESEARCH DESIGN AND METHODS

Data on a longitudinal cohort of veterans with type 2 diabetes was examined. The main outcome was time to death. Primary independent variables were race/ethnicity and mean medication possession ratio (MPR) categorized into quintiles over the study period. Cox regression was used to model the association between time to death and MPR quintiles and race/ethnicity, adjusting for relevant covariates.

RESULTS

The cohort of 629,563 veterans was followed for 5 years. After adjusting for all covariates, the hazard ratios (HR) for subjects in the lowest versus highest MPR quintile was 12.21 (95 % CI 11.89, 12.55) for non-Hispanic white (NHW), 10.01 (95 % CI 9.18, 10.91) for non-Hispanic black (NHB), 12.65 (95 % CI 11.10, 14.43) for Hispanic and 10.41 (95 % CI 9.06, 11.96) for Other race veterans. Furthermore, type of diabetes therapy (oral versus insulin) maintained a significant relationship with mortality that varied by racial/ethnic group.

CONCLUSIONS

This study demonstrates the differential impact of medication non-adherence on mortality by race. It also demonstrates that type of diabetes therapy (insulin with or without oral agents) is associated with mortality and varies by racial/ethnic group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.

Similar content being viewed by others

REFERENCES

  1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

  2. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Available online: http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed August 3, 2012.

  3. Mokdad, A.. Diabetes trends in the U.S.: 1990–1998. Diabetes Care. 2000;23(9): 1278–83. [PMID: 10977060].

  4. Cowie C. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999–2002. Diabetes Care. 2006;29(6):1263–8.

    Article  PubMed  Google Scholar 

  5. Adams AS, Trinacty CM, Zhang F, et al. Medication adherence and racial differences in A1C control. Diabetes Care. 2008;31(5):916–21.

    Article  PubMed  Google Scholar 

  6. Grant R, Adams AS, Trinacty CM, et al. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care. 2007;30(4):807–12.

    Article  PubMed  Google Scholar 

  7. Trinacty CM, Adams AS, Soumerai SB, et al. Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study. BMC Health Serv Res. 2009;9:24.

    Article  PubMed  Google Scholar 

  8. Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004;27(9):2149–53.

    Article  PubMed  CAS  Google Scholar 

  9. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836–41.

    Article  PubMed  Google Scholar 

  10. Heisler M, Choi H, Rosen AB, et al. Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. Med Care. 2010;48(2):87–94.

    PubMed  Google Scholar 

  11. Kuo YF, Raji MA, Markides KS, Ray LA, Espino DV, Goodwin JS. Inconsistent use of diabetes medications, diabetes complications, and mortality in older Mexican Americans over a 7-year period: data from the Hispanic established population for the epidemiologic study of the elderly. Diabetes Care. 2003;26(11):3054–60.

    Article  PubMed  Google Scholar 

  12. Balkrishnan R, Rajagopalan R, Camacho FT, Huston SA, Murray FT, Anderson RT. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther. 2003;25(11):2958–71.

    Article  PubMed  Google Scholar 

  13. Miller DR, Safford MM, Pogach LM. Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care. 2004;27(Suppl 2):B10–21.

    Article  PubMed  Google Scholar 

  14. West AN, Lee RE, Shambaugh-Miller MD, et al. Defining “rural” for veterans’ health care planning. J Rural Health. Fall;26(4):301–9. [PMID: 21029164].

  15. Department of Veterans Affairs Field Research Advisory Committee. (2004). Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Field Research Advisory Committee Operating Procedures. Available online: http://www.research.va.gov/about/frac/FRAC-ops.pdf Accessed August 3, 2012.

  16. SAS statistical software, version 9.2. SAS Institute Inc, Cary, NC.

  17. Cramer JA, Benedict A, Muszbek N, et al. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62:76–87.

    Article  PubMed  CAS  Google Scholar 

  18. Hertz RP, Unger AN, Lustik MB. Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance. Clin Ther. 2005;27(7):1064–73.

    Article  PubMed  Google Scholar 

  19. Lynch CP, Gebregziabher M, Echols C, Gilbert GE, Zhao Y, Egede LE. Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes. J Gen Intern Med. Jun 8 2010. [PMID: 20532659].

    Google Scholar 

  20. Jha AK, Shlipak MG, et al. (2001). “Racial differences in mortality among men hospitalized in the Veterans Affairs health care system.” JAMA. Jan 17 2001;285(3): 297–303. [PMID: 11176839].

  21. Volpp KG, Stone R, Lave JR, et al. Is thirty-day hospital mortality really lower for black veterans compared with white veterans? Health Serv Res. 2007;42(4):1613–31.

    Article  PubMed  Google Scholar 

  22. Cramer JA, Pugh MJ. The influence of insulin use on glycemic control: how well do adults follow prescriptions for insulin? Diabetes Care. 2005;28:78–83.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funders

This study was supported by grant #IIR-06-219 funded by the VHA Health Services Research and Development (HSR&D) program. The funding agency did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The manuscript represents the views of the authors and not those of the VA or HSR&D. All authors had access to the data and contributed to the manuscript

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H Johnson Veterans Affairs Medical Center, P.O. Box 250593, Charleston, SC, 29425-0593, USA

    Leonard E. Egede MD, MS, Cheryl P. Lynch MD, MPH, Mulugeta Gebregziabher PhD, Kelly J. Hunt PhD, Carrae Echols MS & Gregory E. Gilbert EdD, MSPH, PStat®

  2. Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA

    Leonard E. Egede MD, MS, Cheryl P. Lynch MD, MPH & Patrick D. Mauldin PhD

  3. Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Mulugeta Gebregziabher PhD & Kelly J. Hunt PhD

  4. Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Patrick D. Mauldin PhD

  5. Division of General Internal Medicine & Geriatrics, 109 Bee Street, Charleston, SC, 29401, USA

    Patrick D. Mauldin PhD

Authors
  1. Leonard E. Egede MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheryl P. Lynch MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mulugeta Gebregziabher PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelly J. Hunt PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carrae Echols MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gregory E. Gilbert EdD, MSPH, PStat®
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patrick D. Mauldin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonard E. Egede MD, MS.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 131 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Egede, L.E., Lynch, C.P., Gebregziabher, M. et al. Differential Impact of Longitudinal Medication Non-Adherence on Mortality by Race/Ethnicity among Veterans with Diabetes. J GEN INTERN MED 28, 208–215 (2013). https://doi.org/10.1007/s11606-012-2200-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-012-2200-8

KEY WORDS

Search

Navigation