Medication Nonadherence After Lung Transplantation in Adult Recipients.
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BORIS DOI
Date of Publication
January 2017
Publication Type
Article
Division/Institute
Contributor
Castleberry, Anthony W | |
Bishawi, Muath | |
Erhunmwunsee, Loretta | |
Speicher, Paul J | |
Osho, Asishana A | |
Snyder, Laurie D | |
Hartwig, Matthew G |
Subject(s)
Series
The Annals of Thoracic Surgery
ISSN or ISBN (if monograph)
1552-6259
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
27624294
Description
BACKGROUND
Our objective was to identify potential avenues for resource allocation and patient advocacy to improve outcomes by evaluating the association between recipient sociodemographic and patient characteristics and medication nonadherence after lung transplantation.
METHODS
States US adult, lung-only transplantations per the United Network for Organ Sharing database were analyzed from October 1996 through December 2006, based on the period during which nonadherence information was recorded. Generalized linear models were used to determine the association of demographic, disease, and transplantation center characteristics with early nonadherence (defined as within the first year after transplantation) as well as late nonadherence (years 2 to 4 after transplantation). Outcomes comparing adherent and nonadherent patients were also evaluated.
RESULTS
Patients (n = 7,284) were included for analysis. Early and late nonadherence rates were 3.1% and 10.6%, respectively. Factors associated with early nonadherence were Medicaid insurance compared with private insurance (adjusted odds ratio [AOR] 2.45, 95% confidence interval [CI]: 1.16 to 5.15), and black race (AOR 2.38, 95% CI: 1.08 to 5.25). Medicaid insurance and black race were also associated with late nonadherence (AOR 2.38, 95% CI: 1.51 to 3.73 and OR 1.73, 95% CI: 1.04 to 2.89, respectively), as were age 18 to 20 years (AOR 3.41, 95% CI: 1.29 to 8.99) and grade school or lower education (AOR 1.88, 95% CI: 1.05 to 3.35). Early and late nonadherence were both associated with significantly shorter unadjusted survival (p < 0.001).
CONCLUSIONS
Identifying patients at risk of nonadherence may enable resource allocation and patient advocacy to improve outcomes.
Our objective was to identify potential avenues for resource allocation and patient advocacy to improve outcomes by evaluating the association between recipient sociodemographic and patient characteristics and medication nonadherence after lung transplantation.
METHODS
States US adult, lung-only transplantations per the United Network for Organ Sharing database were analyzed from October 1996 through December 2006, based on the period during which nonadherence information was recorded. Generalized linear models were used to determine the association of demographic, disease, and transplantation center characteristics with early nonadherence (defined as within the first year after transplantation) as well as late nonadherence (years 2 to 4 after transplantation). Outcomes comparing adherent and nonadherent patients were also evaluated.
RESULTS
Patients (n = 7,284) were included for analysis. Early and late nonadherence rates were 3.1% and 10.6%, respectively. Factors associated with early nonadherence were Medicaid insurance compared with private insurance (adjusted odds ratio [AOR] 2.45, 95% confidence interval [CI]: 1.16 to 5.15), and black race (AOR 2.38, 95% CI: 1.08 to 5.25). Medicaid insurance and black race were also associated with late nonadherence (AOR 2.38, 95% CI: 1.51 to 3.73 and OR 1.73, 95% CI: 1.04 to 2.89, respectively), as were age 18 to 20 years (AOR 3.41, 95% CI: 1.29 to 8.99) and grade school or lower education (AOR 1.88, 95% CI: 1.05 to 3.35). Early and late nonadherence were both associated with significantly shorter unadjusted survival (p < 0.001).
CONCLUSIONS
Identifying patients at risk of nonadherence may enable resource allocation and patient advocacy to improve outcomes.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| Medication Nonadherence After Lung Transplantation in Adult.pdf | text | Adobe PDF | 299.07 KB | Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4.0) | accepted | ||
| 1-s2.0-S0003497516307834-main.pdf | text | Adobe PDF | 363.7 KB | publisher | published |