Get access

Sex Differences in Barriers to Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence Among Older Adults

Authors

  • Elizabeth Holt PhD, MPH,

    1. Center for Health Research, Ochsner Clinic Foundation, New Orleans, Louisiana
    2. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
    Search for more papers by this author
  • Cara Joyce MS,

    1. Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
    Search for more papers by this author
  • Adriana Dornelles ScD, MPH,

    1. Center for Health Research, Ochsner Clinic Foundation, New Orleans, Louisiana
    Search for more papers by this author
  • Donald Morisky ScD, MSPH,

    1. Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
    Search for more papers by this author
  • Larry S. Webber PhD,

    1. Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
    Search for more papers by this author
  • Paul Muntner PhD,

    1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Louisiana
    Search for more papers by this author
  • Marie Krousel-Wood MD, MSPH

    Corresponding author
    1. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
    2. Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana
    • Center for Health Research, Ochsner Clinic Foundation, New Orleans, Louisiana
    Search for more papers by this author

Address correspondence to Marie Krousel-Wood, Ochsner Clinic Foundation, Center for Health Research, 1514 Jefferson Highway, New Orleans, LA 70121. E-mail: mawood@ochsner.org

Abstract

Objectives

To determine whether sociodemographic, clinical, healthcare system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores in older men and women.

Design

Cross-sectional analysis of baseline data.

Setting

Cohort Study of Medication Adherence in Older Adults (N = 2,194).

Measurements

Low antihypertensive medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale. Information on risk factors for low adherence was collected using telephone surveys and administrative databases.

Results

The prevalence of low medication adherence scores did not differ according to sex (women, 15.0%; men 13.1%; P = .21). In sex-specific multivariable models, having problems with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores in men and women. Factors associated with low adherence scores in men but not women were poor sexual functioning (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.31–3.16 for men and OR = 1.28, 95% CI = 0.90–1.82 for women), and body mass index of 25.0 kg/m2 or more (OR = 3.23, 95% CI = 1.59–6.59 for men; OR = 1.23, 95% CI = 0.82–1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75, 95% CI = 1.16–2.65 for women; OR = 1.16, 95% CI = 0.57–2.34 for men) and depressive symptoms (OR = 2.29, 95% CI = 1.55–3.38 for women; OR = 0.93, 95% CI = 0.48–1.80 for men).

Conclusion

Factors associated with low antihypertensive medication adherence scores differed according to sex. Interventions designed to improve adherence in older adults should be customized to account for the sex of the target population.

Ancillary