TY - JOUR
T1 - Nonadherence to statins and antihypertensives and hospitalizations among elderly medicare beneficiaries with incident cancer
AU - Chopra, Ishveen
AU - Dwibedi, Nilanjana
AU - Mattes, Malcolm D.
AU - Tan, Xi
AU - Findley, Patricia
AU - Sambamoorthi, Usha
N1 - Funding Information:
From the Departments of aPharmaceutical Systems and Policy, West Virginia University School of Pharmacy, and bRadiation Oncology, West Virginia University School of Medicine, Morgantown, West Virginia; and cSchool of Social Work, Rutgers University, New Brunswick, New Jersey. Submitted January 27, 2017; accepted for publication June 7, 2017. The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. Research reported in this publication was supported by the National Institute of General Medical Sciences of the NIH, award number U54GM104942. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Author contributions: Study design: Chopra, Sambamoorthi. Data analysis: Chopra, Sambamoorthi. Implementation: Chopra. Manuscript preparation: Chopra. Critical review: Sambamoorthi. Feedback on manuscript: Dwibedi, Mattes, Tan, Findley. Correspondence: Nilanjana Dwibedi, MBA, PhD, Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Robert C. Byrd Health Sciences Center, PO Box 9510, Morgantown, WV 26506-9510. E-mail: nidwibedi@hsc.wvu.edu
Publisher Copyright:
© JNCCN - Journal of the National Comprehensive Cancer Network.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background: Incident cancer diagnosis may increase the risk of coronary artery disease (CAD)-related hospitalizations, especially in older individuals. Adherence to statins and/or angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs)/β-blockers reduces CAD-related hospitalizations. This study examined the relationship between medication adherence and CAD-related hospitalizations immediately following cancer diagnosis. Patients and Methods: A retrospective observational longitudinal study was conducted using SEER-Medicare data. Elderly Medicare fee-for-service beneficiaries with preexisting CAD and incident breast, colorectal, or prostate cancer (N=12,096) were observed for 12 months before and after cancer diagnosis. Hospitalizations measured every 120 days were categorized into CAD-related hospitalization, other hospitalization, and no hospitalization. Medication adherence was categorized into 5 mutually exclusive groups: adherent to both statins and ACEIs/ARBs/β-blockers (reference group), not adherent to both statins and ACEIs/ARBs/β-blockers, adherent to either statins or ACEIs/ARBs/β-blockers, use of one medication class and adherent to that class, and use of one medication class and not adherent to that class. The relationship between medication adherence and hospitalization was analyzed using repeated measures multinomial logistic regressions. Inverse probability treatment weights were used to control for observed group differences among medication adherence categories. Results: Adherence to both statins and ACEIs/ARBs/β-blockers was estimated at 31.2% during the 120-day period immediately following cancer diagnosis; 13.7% were not adherent to both medication classes during the same period, and 27.4% had CAD-related hospitalizations immediately after cancer diagnosis, which declined to 10.6% during the last 4 months of the postdiagnosis period. In the adjusted analyses, those not adherent to both statins and ACEIs/ARBs/β-blockers were more likely to have CAD-related hospitalization compared with those adherent to both medication classes (adjusted odds ratio, 1.82; 95% CI, 1.72-1.92; P<.0001). Conclusions: Given the complexity of interaction between CAD and cancer, it is important to routinely monitor medication adherence in general clinical practice and to provide linkages to support services that can increase medication adherence.
AB - Background: Incident cancer diagnosis may increase the risk of coronary artery disease (CAD)-related hospitalizations, especially in older individuals. Adherence to statins and/or angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs)/β-blockers reduces CAD-related hospitalizations. This study examined the relationship between medication adherence and CAD-related hospitalizations immediately following cancer diagnosis. Patients and Methods: A retrospective observational longitudinal study was conducted using SEER-Medicare data. Elderly Medicare fee-for-service beneficiaries with preexisting CAD and incident breast, colorectal, or prostate cancer (N=12,096) were observed for 12 months before and after cancer diagnosis. Hospitalizations measured every 120 days were categorized into CAD-related hospitalization, other hospitalization, and no hospitalization. Medication adherence was categorized into 5 mutually exclusive groups: adherent to both statins and ACEIs/ARBs/β-blockers (reference group), not adherent to both statins and ACEIs/ARBs/β-blockers, adherent to either statins or ACEIs/ARBs/β-blockers, use of one medication class and adherent to that class, and use of one medication class and not adherent to that class. The relationship between medication adherence and hospitalization was analyzed using repeated measures multinomial logistic regressions. Inverse probability treatment weights were used to control for observed group differences among medication adherence categories. Results: Adherence to both statins and ACEIs/ARBs/β-blockers was estimated at 31.2% during the 120-day period immediately following cancer diagnosis; 13.7% were not adherent to both medication classes during the same period, and 27.4% had CAD-related hospitalizations immediately after cancer diagnosis, which declined to 10.6% during the last 4 months of the postdiagnosis period. In the adjusted analyses, those not adherent to both statins and ACEIs/ARBs/β-blockers were more likely to have CAD-related hospitalization compared with those adherent to both medication classes (adjusted odds ratio, 1.82; 95% CI, 1.72-1.92; P<.0001). Conclusions: Given the complexity of interaction between CAD and cancer, it is important to routinely monitor medication adherence in general clinical practice and to provide linkages to support services that can increase medication adherence.
UR - http://www.scopus.com/inward/record.url?scp=85033771515&partnerID=8YFLogxK
U2 - 10.6004/jnccn.2017.0168
DO - 10.6004/jnccn.2017.0168
M3 - Article
C2 - 29118227
AN - SCOPUS:85033771515
SN - 1540-1405
VL - 15
SP - 1351
EP - 1360
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 11
ER -