Study: Neighborhoods With Lower Socioeconomic Status Linked to Lower Adherence Rates for Those With Heart Failure

Patients with heart failure with reduced ejection fraction (HFrEF) who are living in neighborhoods with lower neighborhood-level socioeconomic status are at higher risk of nonadherence to their medical therapy, according to results of a study published in JAMA Network Open. According to the study authors, the results of the study show the importance of considering neighborhood-level disparities to address and improve medication adherence.¹

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“Our findings highlight the importance of considering neighborhood socioeconomic status when developing interventions to ensure [patients] with [HF] have access to their medications,” Amrita Mukhopadhyay, MD, assistant professor of cardiology in the Department of Medicine at NYU Langone Health, said in a press release.²

Investigators included data from electronic health records from NYU Langone Health, linking it to medication fill data from pharmacies and pharmacy benefit managers. Individuals were included if they had a HF diagnosis, prior left ventricular ejection fraction of 40% or less, and a prescription for at least 1 guideline-directed medical therapy between June 30, 2020, and June 30, 2021.¹

There were 6247 individuals included in the study with a mean age of 73 years and the majority were male. Approximately 16.2% were Black, 11.8% were Hispanic/Latinx, and 62.9% were White. The study authors reported that those living in areas with lower neighborhood-level socioeconomic status tended to be younger, Black or Hispanic/Latinx, Spanish-speaking, and on Medicaid. Furthermore, they reported that access to transportation and pharmacy density was lower for those in lower neighborhood-level socioeconomic status areas, with a higher walkability.¹

The study authors found that the percentage of individuals who were not adherent to their medication therapy was higher for those in lower areas of neighborhood-level socioeconomic status and missing neighborhood-level socioeconomic status. Individuals in the 2 lowest neighborhood-level socioeconomic status had higher odds of nonadherence compared to the highest quartile, but those in the third quartile had similar odds of nonadherence. Patients who had missing neighborhood-level socioeconomic status data also had higher odds of adherence compared to the highest quartile, according to the study authors.¹

“These results support targeting interventions that have already been shown to improve medication adherence, such as patient education programs and frequent follow-up with health care professionals, for those living in the most at-risk areas,” Saul Blecker, MD, an associate professor in the Departments of Population Health and Medicine at NYU Langone, said in a press release.²

Investigators also found that there was no significant interaction between race or ethnicity, including both neighborhood-level socioeconomic status and odds of nonadherence. Further, there were no significant indirect effects, including transportation or pharmacy density in this study; however, walkability did have a small, but statistically significant indirect effect, contributing to approximately 7% of variability in the probability of nonadherence for the lowest 2 quartiles compared to the highest.¹

In the press release, Blacker indicated that though there is a connection between socioeconomic status and medication adherence, there is no information on the specific factors that contribute to the gap in adherence.²

“Now that we have uncovered this disparity at a neighborhood level, we next need to explore additional barriers patients may be facing, such as the cost of drugs, language barriers, and discrimination by pharmacy staff,” Samrachana Adhikari, PhD, an associate professor in the Department of Population Health at NYU Langone, said in the press release.²

References

1. Mukhopadhyay A, Blecker S, Li X, Kronish IM, et al. Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure. JAMA Netw Open. 2023;6(12):e2347519. doi:10.1001/jamanetworkopen.2023.47519
2. Where patients live impacts whether they pick up their heart-failure medications. News release. EurekAlert. December 14, 2023. Accessed December 18, 2023. https://www.eurekalert.org/news-releases/1010518