Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus
Abstract
:‘Drugs don’t work in patients who don’t take them’.[1]—C. E. Koop, M.D.
1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Dependent Variable
2.3. Independent Variables
2.4. Statistical Analysis
2.5. Ethical Considerations
3. Results
3.1. Respondents’ Characteristics by the Level of Medication Adherence
3.2. Respondents’ Self-Reported Medication Non-Adherence by the MGL Medication Adherence Scale
3.3. Factors Influencing Medication Non-Adherence among Older Adults with DM
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
DM | Diabetes Mellitus |
T2DM | Type 2 Diabetes Mellitus |
MGL | Morisky–Green–Levine Medication Adherence Scale |
UEBMI | Urban Employee Basic Medical Insurance |
URRBMI | Urban and Rural Residents Basic Medical Insurance |
OHA | Oral Hypoglycemic Agent |
COR | Crude Odds Ratio |
AOR | Adjusted Odds Ratio |
References
- Bonaccorso, S.; Sturchio, J.L. Perspectives from the pharmaceutical industry. BMJ 2003, 327, 863–864. [Google Scholar] [CrossRef] [Green Version]
- WHO. Diabetes Fact Sheet. Available online: https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed on 7 May 2020).
- Alberti, K.G.M.M.; Zimmet, P.Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabet. Med. 1998, 15, 539–553. [Google Scholar] [CrossRef]
- WHO. Global Report on Diabetes; WHO: Geneva, Switzerland, 2016. [Google Scholar]
- Saeedi, P.; Petersohn, I.; Salpea, P.; Malanda, B.; Karuranga, S.; Unwin, N.; Colagiuri, S.; Guariguata, L.; Motala, A.A.; Ogurtsova, K.; et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res. Clin. Pract. 2019, 157, 107843. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- WHO. The Top 10 Causes of Death Fact Sheet. Available online: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (accessed on 7 May 2020).
- Polonsky, W.H.; Henry, R.R. Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Prefer. Adherence 2016, 10, 1299–1307. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Currie, C.J.; Peyrot, M.; Morgan, C.L.; Poole, C.D.; Jenkins-Jones, S.; Rubin, R.R.; Burton, C.M.; Evans, M. The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care 2012, 35, 1279–1284. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Osterberg, L.; Blaschke, T. Adherence to Medication. N. Engl. J. Med. 2005, 353, 487–497. [Google Scholar] [CrossRef] [Green Version]
- Marcum, Z.A.; Sevick, M.A.; Handler, S.M. Medication Nonadherence: A Diagnosable and Treatable Medical Condition. JAMA 2013, 309, 2105–2106. [Google Scholar] [CrossRef]
- Breitscheidel, L.; Stamenitis, S.; Dippel, F.W.; Schöffski, O. Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: A review paper. J. Med. Econ. 2010, 13, 8–15. [Google Scholar] [CrossRef]
- Ho, P.M.; Rumsfeld, J.S.; Masoudi, F.A.; McClure, D.L.; Plomondon, M.E.; Steiner, J.F.; Magid, D.J. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch. Intern. Med. 2006, 166, 1836–1841. [Google Scholar] [CrossRef] [Green Version]
- Kim, Y.-Y.; Lee, J.-S.; Kang, H.-J.; Park, S.M. Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients. Sci. Rep. 2018, 8, 12190. [Google Scholar] [CrossRef]
- Mata, A.R.d.; Álvares, J.; Diniz, L.M.; Ruberson Ribeiro da Silva, M.; Alvernaz dos Santos, B.R.; Guerra Júnior, A.A.; Cherchiglia, M.L.; Andrade, E.I.G.; Godman, B.; Acurcio, F.d.A. Quality of life of patients with Diabetes Mellitus Types 1 and 2 from a referral health centre in Minas Gerais, Brazil. Expert Rev. Clin. Pharmacol. 2016, 9, 739–746. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pinzone, H.A.; Carlson, B.W.; Kotses, H.; Creer, T.L. Prediction of asthma episodes in children using peak expiratory flow rates, medication compliance, and exercise data. Ann. Allergy 1991, 67, 481–486. [Google Scholar] [PubMed]
- WHO. Adherence to Long-Term Therapies: Evidence for Action; WHO: Geneva, Switzerland, 2003. [Google Scholar]
- IDF. IDF Diabetes Atlas, 8th ed.; IDF: Brussels, Belgium, 2019. [Google Scholar]
- United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2015 (ST/ESA/SER.A/390). Available online: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf (accessed on 7 May 2020).
- Xu, H.; Zou, C. Multivariate logistic regression analysis of the compliance in elderly diabetes and countermeasures. Chin. J. Biochem. Pharm. 2016, 36, 189–191. [Google Scholar]
- Hao, J.; Yu, H. Investigation and analysis of long-term medication compliance in 130 elderly patients with type 2 diabetes. Chin. J. Hosp. Pharm. 2019, 39, 1687–1690. [Google Scholar]
- Hao, X. Influencing factors investigation of compliance in elderly diabetic patients of outpatient clinic. Clin. Res. Pract. 2018, 3, 115–116. [Google Scholar]
- Wang, Q.; Xu, L.; Li, J.; Sun, L.; Qin, W.; Ding, G.; Zhu, J.; Zhang, J.; Yu, Z.; Xie, S. Association of Anthropometric Indices of Obesity with Hypertension in Chinese Elderly: An Analysis of Age and Gender Differences. Int. J. Environ. Res. Public Health 2018, 15, 801. [Google Scholar] [CrossRef] [Green Version]
- Morisky, D.E.; Green, L.W.; Levine, D.M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care 1986, 24, 67–74. [Google Scholar] [CrossRef]
- Nonogaki, A.; Heang, H.; Yi, S.; van Pelt, M.; Yamashina, H.; Taniguchi, C.; Nishida, T.; Sakakibara, H. Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study. PLoS ONE 2019, 14, e0225000. [Google Scholar] [CrossRef] [Green Version]
- Achouri, M.Y.; Mammeri, M.; Sehanine, Y.; Selka, M.A.; Ghomari, W.I.; Lahmer, A.; Hadj Habib, M. Facteurs associés à la non-observance thérapeutique chez les diabétiques de type 2: Première enquête algérienne. Ann. Pharm. Fr. 2019, 77, 506–515. [Google Scholar] [CrossRef]
- Kalyango, J.N.; Owino, E.; Nambuya, A.P. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: Prevalence and associated factors. Afr. Health Sci. 2008, 8, 67–73. [Google Scholar]
- Zivin, K.; Ratliff, S.; Heisler, M.M.; Langa, K.M.; Piette, J.D. Factors influencing cost-related nonadherence to medication in older adults: A conceptually based approach. Value Health 2010, 13, 338–345. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Aminde, L.N.; Tindong, M.; Ngwasiri, C.A.; Aminde, J.A.; Njim, T.; Fondong, A.A.; Takah, N.F. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr. Disord. 2019, 19, 35. [Google Scholar] [CrossRef] [Green Version]
- Elsous, A.; Radwan, M.; Al-Sharif, H.; Abu Mustafa, A. Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine. Front. Endocrinol. (Lausanne) 2017, 8, 100. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kini, V.; Ho, P.M. Interventions to Improve Medication Adherence: A Review. JAMA 2018, 320, 2461–2473. [Google Scholar] [CrossRef] [PubMed]
- Awodele, O.; Osuolale, J.A. Medication adherence in type 2 diabetes patients: Study of patients in Alimosho General Hospital, Igando, Lagos, Nigeria. Afr. Health Sci. 2015, 15, 513–522. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Characteristics | Total | Adherent | Non-Adherent | χ2 | p-Value |
---|---|---|---|---|---|
N | 1002 | 803 (80.1) | 199 (19.9) | ||
Social and economic factors | |||||
Gender | 5.456 | 0.019 | |||
Male | 305 (30.4) | 258 (84.6) | 47 (15.4) | ||
Female | 697 (69.6) | 545 (78.2) | 152 (21.8) | ||
Residence | 4.527 | 0.104 | |||
Urban | 326 (32.5) | 273 (59.4) | 53 (64.0) | ||
Township | 72 (7.2) | 54 (6.7) | 18 (9.1) | ||
Rural | 604 (60.3) | 476 (33.9) | 128 (26.9) | ||
Age group | 5.224 | 0.073 | |||
60–69 | 528 (52.7) | 409 (77.5) | 119 (22.5) | ||
70–79 | 433 (43.2) | 361 (83.4) | 72 (16.6) | ||
≥80 | 41 (4.1) | 33 (80.5) | 8 (19.5) | ||
Education level a | 2.953 | 0.086 | |||
Junior or above | 286 (28.5) | 239 (83.6) | 47 (16.4) | ||
Below junior | 716 (71.5) | 564 (78.8) | 152 (21.2) | ||
Marital status | 2.863 | 0.091 | |||
Married | 831 (82.9) | 674 (81.1) | 157 (18.9) | ||
Single b | 171 (17.1) | 129 (75.4) | 42 (24.6) | ||
Employment status | 1.927 | 0.165 | |||
Employed | 225 (22.5) | 173 (76.9) | 52 (23.1) | ||
Unemployed c | 777 (77.5) | 630 (81.1) | 147 (18.9) | ||
Personal Annual Income | 3.850 | 0.050 | |||
USD >8882.7 | 32 (3.2) | 30 (93.8) | 2 (6.2) | ||
USD 0–8882.7 | 970 (96.8) | 773 (80.0) | 197 (20.0) | ||
Health care team and system-related factors | |||||
Health insurance d | 3.469 | 0.176 | |||
UEBMS | 262 (26.1) | 220 (84.0) | 42 (16.0) | ||
URRBMS | 707 (70.6) | 556 (78.6) | 151 (21.4) | ||
Others/None | 33 (3.3) | 27 (81.8) | 6 (18.2) | ||
Condition-related factors | |||||
Disease duration | 7.354 | 0.007 | |||
<5 years | 327 (32.6) | 246 (75.2) | 81 (24.8) | ||
≥5 years | 675 (67.4) | 557 (82.5) | 118 (17.5) | ||
Complication | 0.312 | 0.576 | |||
No | 843 (84.1) | 673 (79.8) | 170 (20.2) | ||
Yes | 159 (15.9) | 130 (81.8) | 29 (18.2) | ||
Therapy-related factors | |||||
Type of medication | 3.323 | 0.190 | |||
OHA e | 846 (84.4) | 670 (79.2) | 176 (86.6) | ||
Insulin | 70 (7.0) | 61 (8.1) | 9 (5.2) | ||
Both | 86 (8.6) | 72 (9.6) | 14 (8.1) | ||
Patient-related factors | |||||
Perceived importance of medication adherence | 5.120 | 0.024 | |||
Important | 908 (90.6) | 736 (81.1) | 172 (18.9) | ||
Unimportant | 94 (9.4) | 67 (71.3) | 27 (28.7) | ||
Self-rated mental health status | 4.080 | 0.130 | |||
Good | 756 (75.4) | 616 (81.5) | 140 (18.5) | ||
Normal | 183 (18.3) | 137 (74.9) | 46 (25.1) | ||
Poor | 63 (6.3) | 50 (79.4) | 13 (20.6) |
Item of the MGL Medication Adherence Scale a | Frequency (Yes) | Percentage (%) |
Do you ever forget to take your medicine? | 421 | 42.0 |
Are you careless at times about taking your medicine? | 299 | 29.8 |
When you feel better, do you sometimes stop taking your medicine? | 254 | 25.4 |
Sometimes if you feel worse when you take the medicine, do you stop taking it? | 170 | 17.0 |
Level of Medication Adherence | Frequency | Proportion (%) |
High adherence | 463 | 46.2 |
Moderate adherence | 340 | 33.9 |
Low adherence | 199 | 19.9 |
Intentional versus Unintentional Non-adherence | Frequency | Percentage (%) |
Unintentional non-adherence | 446 | 44.5 |
Intentional non-adherence | 333 | 33.2 |
Both | 240 | 24.0 |
Total | 1002 | 100.0 |
Characteristics | Level | Unadjusted Model | Adjusted Model a | ||
---|---|---|---|---|---|
(Reference Group) | COR b (95% CI) | p-Value | AOR c (95% CI) | p-Value | |
Gender (Male) | Female | 1.53 (1.07–2.19) | 0.020 | 1.56 (1.09–2.24) | 0.016 |
Residence (Urban) | Township | 1.72 (0.93–3.16) | 0.082 | ||
Rural | 1.39 (0.97–1.97) | 0.070 | |||
Age group (60–69) | 70–79 | 0.69 (0.50–0.95) | 0.023 | ||
≥80 | 0.83 (0.37–1.85) | 0.654 | |||
Education level (Junior or above) | Below junior | 0.90 (0.79–1.03) | 0.113 | ||
Marital status (Married) | Single | 1.40 (0.95–2.06) | 0.092 | ||
Employment status (Employed) | Unemployed | 0.78 (0.54–1.11) | 0.166 | ||
Personal annual income (USD >8882.7) | USD 0–8882.7 | 3.82 (0.91–16.13) | 0.068 | ||
Insurance (UEBMI) | URRBMI | 1.42 (0.98–2.07) | 0.066 | ||
Others/None | 1.16 (0.45–2.99) | 0.753 | |||
Disease duration (<5 years) | ≥5 years | 0.64 (0.47–0.89) | 0.007 | 0.63 (0.46–0.87) | 0.005 |
Complication (No) | Yes | 0.88 (0.57–1.37) | 0.577 | ||
Type of medication (OHA) | Insulin | 0.56 (0.27–1.15) | 0.116 | ||
Both | 0.74 (0.41–1.34) | 0.323 | |||
Perceived importance of adherence (Important) | Unimportant | 1.72 (1.07–2.78) | 0.025 | 1.69 (1.05–2.74) | 0.032 |
Mental health status (Good) | Normal | 1.48 (1.01–2.16) | 0.045 | ||
Poor | 1.14 (0.60–2.16) | 0.679 |
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Xu, N.; Xie, S.; Chen, Y.; Li, J.; Sun, L. Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus. Int. J. Environ. Res. Public Health 2020, 17, 6012. https://doi.org/10.3390/ijerph17176012
Xu N, Xie S, Chen Y, Li J, Sun L. Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus. International Journal of Environmental Research and Public Health. 2020; 17(17):6012. https://doi.org/10.3390/ijerph17176012
Chicago/Turabian StyleXu, Ningze, Shiyu Xie, Yingyao Chen, Jiajia Li, and Long Sun. 2020. "Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus" International Journal of Environmental Research and Public Health 17, no. 17: 6012. https://doi.org/10.3390/ijerph17176012