Impact of Social Determinants of Health on Chronic Conditions
Socioeconomic status may play a critical role in reduced adherence to treatments among patients with psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), Jean Park, MD, explained during her presentation at the ACR Convergence on November 13.
Dr Park currently serves as assistant vice president of National Accounts at CVS Health/Aetna.
“Patients with rheumatoid arthritis (RA) had significantly higher rates of adherence compared to patients with PsA and SLE,” Dr Park added.
Investigators pulled data from fully insured adults more than 18 years of age who had at least 2 clinical visits for RA, PsA, and SLE during the study period and received medication therapy for their disease. They measured medication adherence as the proportion of days covered.
Of the 50,817 patients included in this study, 35,573 (70%) had RA, 8,161 (16.1%) had PsA, and 7,083 (13.9%) had SLE. Patients who had RA were older (mean age 58.4) than those who had PsA (mean age 51.6) and SLE (mean age 48.7). The patients who had RA were also more ill at baseline compared to those who had PsA and SLE.
Factors that impacted low adherence were:
- lower socioeconomic status (OR [95%CI]: 0.89);
- presence of liver disease (OR [95%CI]: 0.75);
- presence of cardiovascular disease (OR [95%CI]: 0.92);
- increases in food stamps (OR [95%CI]: 0.54);
- lack of access to public transportation (OR [95%CI]: 0.68);
- African American race (OR [95%CI]: 0.80); and
- physical inactivity (OR [95%CI]: 0.70)
“More attention and research by health care providers and policymakers is the need of the day,” Dr Park said. While most interventions aimed at improving medication adherence focus on patient education, medication regimen management, and more frequent monitoring including reminders, “we must also appreciate the broader context in which our patients live and design interventions and policies,” Dr Park concluded.
Reference:
Park J. 0176: Impact of social determinants of health factors on medication adherence in members with rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus. Presented at: American College of Rheumatology Convergence. November 12, 2023. San Diego.
