By Dr. Chinta SidharthanReviewed by Susha Cheriyedath, M.Sc.Dec 9 2024
New research uncovers how cultural, social, and healthcare challenges impact medication adherence among women, offering insights to reduce stroke recurrence disparities.
Study: Sex Differences in Nonadherence to Secondary Stroke Prevention Medications Among Patients With First‐Ever Ischemic Stroke. Image Credit: Kateryna Kon / Shutterstock
In a recent study published in the Journal of the American Heart Association, researchers from the University of Michigan investigated the differences between men and women in adhering to medications prescribed after a first ischemic stroke. Using data from a United States (U.S.)-based population study, they evaluated the adherence to various drug classes, explored underlying factors influencing nonadherence, and identified demographic or lifestyle contributors to gender disparities.
Background
Stroke remains a significant public health issue, impacting millions globally, with women often facing worse outcomes than men. Adhering to prescribed medications after a stroke, such as antihypertensives and cholesterol-lowering drugs, reduces the risk of recurrent events and associated mortality. Despite the importance of medication adherence, many stroke survivors fail to follow their treatment regimens.
Ethnic-specific disparities: Mexican American women were three times more likely to be nonadherent to cholesterol-lowering medications than their male counterparts, a disparity not observed among non-Hispanic Whites.
Studies suggest gender disparities in adherence, but the findings have been inconsistent. Some indicate that women are less adherent, while others find the opposite. Moreover, prior research has primarily relied on convenience samples or focused on healthcare settings that may not reflect diverse populations, often overlooking ethnic differences. The specific mechanisms driving these disparities remain poorly understood, emphasizing the need for more targeted and representative investigations.
Understanding these disparities and the specific challenges faced by subgroups such as Mexican Americans is crucial. Furthermore, identifying contributing factors to nonadherence, such as age, marital status, or access to care, may help design targeted interventions to improve adherence and reduce the recurrence of strokes, especially in vulnerable populations.
About the Study
The present study analyzed data from the Brain Attack Surveillance in Corpus Christi (BASIC) project, which focuses on a bi-ethnic U.S. community. The participants were adults above the age of 45 years who had experienced a first ischemic stroke between 2008 and 2019.
To assess medication adherence, the researchers used a modified Morisky scale, a validated measure commonly employed in underserved populations, during structured interviews conducted 90 days post-stroke. The participants provided self-reports on whether they missed doses for prescribed medications, which included antihypertensives, cholesterol-lowering drugs, antiplatelets, and anticoagulants. Nonadherence was defined as missing doses more frequently than "rarely" during a typical week.
Widowhood and adherence: Widowed participants, particularly women, demonstrated better adherence compared to married individuals, possibly due to non-spouse caregivers providing medication management.
The analysis evaluated overall nonadherence and adherence to individual drug classes, using prevalence ratios to examine gender differences. Furthermore, factors potentially contributing to nonadherence, such as demographic, social, health-related, or lifestyle factors, were also analyzed. The researchers employed multiple regression models to isolate the effects of these variables and identify confounding factors.
The researchers used various regression models to quantify these differences, with adjustments for confounders such as age, marital status, and healthcare access. The study further explored how ethnicity or other demographics modified these associations. By targeting a community with predominantly Mexican American and non-Hispanic White participants, they also aimed to gain insights into disparities within a diverse population.
Moreover, telephone or proxy interviews ensured that individuals unable to attend in-person sessions could still participate. The findings aimed to understand the gender-specific patterns in post-stroke medication adherence, emphasizing the roles of societal and healthcare-related factors and exploring the intersectionality of race, gender, and socioeconomic status.
Results
The study found that women had a higher rate than men of missing doses of certain secondary stroke prevention medications, especially antiplatelets and cholesterol-lowering drugs. Furthermore, this gender disparity persisted even after adjusting for a range of demographic and health-related factors. Overall, 13% of women and 10% of men were categorized as nonadherent, with the difference being statistically significant for specific drug classes but not for overall adherence. No significant gender differences were observed in adherence to antihypertensives.
Confounding lifestyle factors: Smoking and alcohol consumption among men and obesity among women significantly influenced nonadherence, yet these factors alone did not fully explain gender disparities.
With regard to demographic influences, the study revealed that age, marital status, and healthcare access significantly contributed to observed disparities. Moreover, although obesity in women and unhealthy lifestyle factors, such as smoking or alcohol consumption in men, were identified as key confounders, they did not fully explain the gender differences. Mexican American women demonstrated exceptionally high rates of nonadherence to cholesterol-lowering drugs compared to other subgroups, which highlighted a need for tailored interventions.
Additionally, the ethnic differences were further emphasized, with the gender disparity in nonadherence being more pronounced among Mexican American individuals than among non-Hispanic Whites. This finding suggests that cultural, social, and caregiving burdens disproportionately impact adherence behaviors in certain subgroups.
However, despite these differences, no significant gender disparity was observed in adherence to antihypertensives. The study also noted that while lifestyle, health system access, and social factors significantly influenced adherence, they varied in their impact across different drug classes. These findings underscored the importance of addressing modifiable risk factors and tailoring adherence strategies to meet the unique needs of subgroups, particularly minority women.
Conclusions
Overall, the findings indicated persistent gender disparities in the adherence to stroke prevention medications, with women, especially Mexican Americans, being more likely to miss doses. The influence of factors such as age, obesity, marital status, lifestyles, and healthcare access partially explained these patterns.
The researchers also stated that targeted interventions addressing these factors, such as providing culturally competent education and improving access to care, along with strategies to support adherence among men with unhealthy lifestyles or limited healthcare access, may help improve outcomes and reduce the burden of recurrent strokes in vulnerable populations. Future studies are recommended to explore psychological, interpersonal, and healthcare quality factors that may further elucidate these disparities.
Journal reference: Chen, C., Reeves, M. J., Farris, K. B., Morgenstern, L. B., & Lisabeth, L. D. (2024). Sex Differences in Nonadherence to Secondary Stroke Prevention Medications Among Patients With First‐Ever Ischemic Stroke. Journal of the American Heart Association, DOI:10.1161/JAHA.124.036409, https://www.ahajournals.org/doi/10.1161/JAHA.124.036409