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Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence among Adults with Asthma

¹ Department of Biostatistics and Research Epidemiology, ² Center for Health Services Research, and ³ Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan

Correspondence and requests for reprints should be addressed to L. Keoki Williams, M.D., M.P.H., Center for Health Services Research, Henry Ford Hospital, 1 Ford Place, 3A CHSR, Detroit, MI 48202. E-mail: kwillia5{at}hfhs.org

Rationale: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among African-American patients when compared with white patients.

Objectives: To understand the factors that contribute to ICS adherence among African-American and white adults with asthma.

Methods: Eligible individuals had a prior diagnosis of asthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internal factors (e.g., patient beliefs, knowledge, and motivation) and external factors (e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICS adherence. Adherence was calculated using electronic prescription and fill data. Stepwise regression was used to identify factors associated with adherence before and after stratifying by race-ethnicity.

Measurements and Main Results: Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internal factors, but not external factors, diminished the relationship between race-ethnicity and ICS adherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantly associated with ICS adherence; it explained 5.6% of the variance in adherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source of asthma control, and readiness to take medication were the internal factors associated with ICS adherence; these accounted for 19.8% of the variance in adherence.

Conclusions: Factors associated with ICS adherence appear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improve adherence.

Key Words: medication adherence • inhaled corticosteroids • asthma • race-ethnicity • patient compliance

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Differences in inhaled corticosteroid (ICS) adherence by race-ethnicity is well described, and may account for disparities in asthma-related outcomes. However, less well known are the factors associated with medication adherence within these groups. What This Study Adds to the Field Here we show that the factors associated with ICS adherence appear to differ between African-American and white patients. This suggests that differing approaches may be needed to improve adherence among these race-ethnic groups and future interventions tailored accordingly.

 

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