Geography and patient history in long-term lipid lowering medication adherence for primary prevention of cardiovascular disease

Publication date: Available online 2 April 2019Source: Spatial and Spatio-temporal EpidemiologyAuthor(s): Feiyu Hu, Jim Warren, Daniel J ExeterAbstractIn order to determine the role of geographical and patient history factors in long-term medication adherence in cardiovascular disease (CVD), we analysed adherence to lipid-lowering therapy in a primary care cohort based on CVD decision support and linked health systems and census data from Auckland, New Zealand. Two-year adherence was examined for 10,410 patients aged between 30∼74 with neither diabetes nor a history of CVD. Using logistic regression we found significant variation in adherence by age, ethnicity and being a new therapy user, and in 9 of 86 geographic zones. A large low-adherence ‘cold-spot’ of 13 contiguous geographic zones was detected through local Getis-Ord Gi* analysis. A set of 42 models to predict adherence was formulated on sets of demographic, geographic and refill history factors. We observed prediction ability to be improved by addition of refill history but not geographical variables, and boosted regression tree (BRT) models outperformed logistic regression.
Source: Spatial and Spatio-temporal Epidemiology - Category: Epidemiology Source Type: research

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Source: Preventive Medicine - Category: International Medicine & Public Health Source Type: research
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