Abstract Details

Title Influence of Race and Ethnicity on Adherence to Secondary Stroke Prevention Medications in an Integrated Managed Care Health System

Topic Health Care Disparities

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 215

Objective To evaluate influence of race and ethnicity on adherence to secondary prevention medications after an index stroke in a setting with equitable access to insurance coverage.

Background Racial/Ethnic minorities in the United States experience poorer stroke outcomes than their non-Hispanic White counterparts. The reasons for this worrisome disparity are likely multifactorial and require a clearer understanding of key contributors in order to mitigate them.

Design/Methods We retrospectively evaluated patients discharged with ischemic stroke from 14 hospitals between January 2007 and June 2015 in an integrated managed-care health system network who received secondary stroke prevention medications after hospitalization. Acceptable medication adherence was defined as ≥80% refill compliance, or that there is a continuous measure of medication gaps (CMG) < 20% of the time (CMG < 0.2). Univariate variables assessments on outcomes by linear or logistic regression served as screening for multivariate model covariate selecting when the significance is better (p-value is less) than 0.25 (for small numbers of patients) or 0.15 (for larger numbers of patients). Backward elimination in the logistic regression was used to develop the receiver operating characteristic (ROC) curve with Hosmer and Lemeshow goodness-of-fit for the model.

Results Among 12,944 eligible patients who filled 426,463 medications during the study period, 12,851 (99.3%) patients met inclusion criteria. There were 8,509 patients with average CMG adherence of -0.14 in the adherent group and 4,342 with average CMG adherence of 0.46 in the nonadherent group. Black race (OR 0.53, 95% CI 0.48 – 0.6) and Hispanic ethnicity (OR 0.65 95% CI 0.58 – 0.71) were associated with decreased medication adherence vs. Non-Hispanic white.

Conclusions Within a large integrated managed care health system, compared to their White counterparts, Black and Hispanic patients were less adherent to secondary prevention drugs after ischemic stroke. Increased outreach, education, and addressing mistrust, may help mitigate these disparities.

Authors/Disclosures
William P. Neil, MD (Kaiser Permanente Neurology) PRESENTER	Dr. Neil has nothing to disclose.
Bruce I. Ovbiagele, MD, MSc, FAAN (San Francisco VA)	Dr. Ovbiagele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Stroke Association. Dr. Ovbiagele has received research support from National Institutes of Health. Dr. Ovbiagele has a non-compensated relationship as a President with Society for Equity Neuroscience that is relevant to AAN interests or activities. Dr. Ovbiagele has a non-compensated relationship as a Board Member with World Stroke Organization that is relevant to AAN interests or activities.

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