Racial differences in adherence to cardiac medications

• Published in: Journal of the National Medical Association Vol. 95; no. 1; pp. 17 - 27
• Main Authors: CHARLES, Hyasmine, GOOD, Chester B, HANUSA, Barbara H, CHANG, Chung-Chou H, WHITTLE, Jeff
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 2003; Elsevier Limited; National Medical Association
• Subjects: African Americans; Age Factors; Aged; Biological and medical sciences; Cardiovascular Agents - therapeutic use; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - ethnology; European Continental Ancestry Group; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Patient Compliance; Pharmacology. Drug treatments; Retrospective Studies; United States - epidemiology; United States; Calcium; Male; Ionic channel; Drug compliance; Adult; Age; Human; Ethnic origin; calcium channel blockers; race; Enzyme; adherence; hypertension hyperlipidemia; Enzyme inhibitor; Statin derivative; Chemotherapy; Treatment; Hydroxymethylglutaryl-CoA reductase; Inhibitor; Oxidoreductases; Caucasoid; Comparative study; ACE inhibitor; African American; Beta blocking agent
• ISSN: 0027-9684; 1943-4693

To determine whether there are racial differences in adherence to cardiac medications. Retrospective analysis. African-American and white male veterans aged 45 years or older who had received any of four groups of drugs: angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BBs), calcium channel blockers (CCBs,) or HMG CoA (hydroxymethyl glutaryl coenzyme A) reductase inhibitors (statins). Administrative records were used to identify eligible veterans and their demographic characteristics, medical diagnoses, and medication use. We used a standard measure of adherence to medications based on whether the veteran obtained enough drug to take it as prescribed on 80% of the days. We identified 833 eligible African-American and 4436 eligible white veterans. In univariable analysis, African Americans were less likely to be adherent to medications than whites for ACEIs (81.4% versus 87.6%, P = 0.004), CCBs (75.3% versus 81.7%, P = 0.003), and statins (59.9% versus 74.1%, P < 0.001) but not BBs (84.8% versus 83.5%, P = 0.6). In multivariable analysis, racial differences in adherence to medications were found primarily among veterans younger than 55 years old. Younger African Americans were less adherent to medications than whites in a setting where financial barriers are minimized. Although the reason for this finding is unclear, it may contribute to high cardiovascular morbidity among African Americans.