ArticleInternational journal of environmental research and public health2020
Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment.
Article in International journal of environmental research and public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 22 citations in OpenAlex.
- Artificial intelligence approaches to predicting treatment non-adherence in chronic diseases: a narrative review.Frontiers in digital health · 2026Review
- The Role of Religiosity on Racial/Ethnic Disparities in Non-adherence to Antihypertensive Medications.Journal of racial and ethnic health disparities · 2025Article
- Survivors of Stroke Face Greater Social Risks Than Adults Who Have Not Had a Stroke: Results From a Nationwide Study.Journal of the American Heart Association · 2025Article
- Patients from distressed communities have decreased survival after open thoracic aneurysm repair.JTCVS open · 2025Article
- Feasibility of deploying community health workers to assist with health-related social needs and hypertension in community care clinics.Journal of clinical and translational science · 2025Article
- Medication Adherence in Stroke Patients: The Role of Social Support, Social Health, Self-Esteem, and Leisure Time.Medical journal of the Islamic Republic of Iran · 2025Article
- Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement.The journal of allergy and clinical immunology. In practice · 2024Review
- Article
- Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure.JAMA network open · 2023Article
- Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States.Journal of medical Internet research · 2023Article
- Social Determinants of Health-Related Z Codes and Health Care Among Patients With Hypertension.AJPM focus · 2023Article
- Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes.International journal of environmental research and public health · 2023Article
- Food Insecurity and Perceived Financial Stress are Associated with Cost-related Medication Non-adherence in Stroke.Journal of health care for the poor and underserved · 2023Article
- Impact of Socioeconomic Status on Heart Failure.Journal of community hospital internal medicine perspectives · 2023Review
- Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review.Patient preference and adherence · 2023Review
- Place-based heterogeneity in lung transplant recipient outcomes.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2022Article
- Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers.American journal of epidemiology · 2022Article
- Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension.American journal of hypertension · 2022Article
- Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review.Kidney medicine · 2022Article
- Medication Adherence: Expanding the Conceptual Framework.American journal of hypertension · 2021Article
Corrections and comments
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Authors and funding
15 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundNon-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors.
methodsTwo cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014-2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries' claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models.
resultsAmong 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31,
conclusionAHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.