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Socioeconomic Inequalities in Statin Adherence Under Universal Coverage: Does Sex Matter? Circ Cardiovasc Qual Outcomes 2016 11;9(6):704-713



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BACKGROUND: Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence. We investigated the relationship between SEP and statin adherence in a country with universal coverage using group-based trajectory modeling in addition to the proportion of days covered.

METHODS AND RESULTS: Using data from Finnish healthcare registers, we identified 116‚ÄČ846 individuals, aged 45 to 75 years, who initiated statin therapy for primary prevention of cardiovascular disease. We measured adherence as proportion of days covered over an 18-month period since initiation and identified different adherence patterns based on monthly adherence with group-based trajectory modeling. When adjusted for age, marital status, residential area, clinical characteristics, and copayment, low SEP was associated with statin nonadherence (proportion of days covered <80%) among men (eg, lowest versus highest income quintile: odds ratio, 1.41; 95% confidence interval, 1.32-1.50; basic versus higher-degree education: odds ratio, 1.18; 95% confidence interval, 1.13-1.24; unemployment versus employment: odds ratio, 1.17; 95% confidence interval, 1.10-1.25). Among women, the corresponding associations were different (P<0.001 for sex-by-income quintile, sex-by-education level, and sex-by-labor market status interactions) and mainly nonsignificant. Results based on adherence trajectories showed that men in low SEP were likely to belong to trajectories presenting a fast decline in adherence.

CONCLUSIONS: Low SEP was associated with overall and rapidly increasing statin nonadherence among men. Conversely, in women, associations between SEP and nonadherence were weak and inconsistent. Group-based trajectory modeling provided insight into the dynamics of statin adherence and its association with SEP.

Author List

Aarnio E, Martikainen J, Winn AN, Huupponen R, Vahtera J, Korhonen MJ


Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiovascular Diseases
Drug Costs
Drug Prescriptions
Educational Status
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Logistic Models
Medication Adherence
Middle Aged
Multivariate Analysis
Odds Ratio
Primary Prevention
Risk Factors
Sex Factors
Socioeconomic Factors
Time Factors
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a