Associations of Community and Individual Social Determinants of Health With Medication Adherence in Patients With Atrial Fibrillation: A Retrospective Cohort Study.
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2023-04
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Abstract
Background Despite guideline-recommended use of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), OAC medication adherence among patients with AF in the United States ranges from 47% to 82%. To characterize potential causes of nonadherence, we analyzed associations between community and individual social risk factors and OAC adherence for stroke prevention in AF. Methods and Results A retrospective cohort analysis of patients with AF was conducted using the IQVIA PharMetrics Plus claims data from January 2016 to June 2020, and 3-digit ZIP code-level social risk scores were calculated using American Community Survey and commercial data. Logistic regression models evaluated associations between community social determinants of health, community social risk scores for 5 domains (economic climate, food landscape, housing environment, transportation network, and health literacy), patient characteristics and comorbidities, and 2 adherence outcomes: persistence on OAC for 180 days and proportion of days covered ≥0.80 at 360 days. Of 28 779 patients with AF included in the study, 70.8% of patients were male, 94.6% were commercially insured, and the average patient age was 59.2 years. Multivariable regression found that greater health literacy risk was negatively associated with 180-day persistence (odds ratio [OR]=0.80 [95% CI, 0.76-0.83]) and 360-day proportion of days covered (OR, 0.81 [95% CI, 0.76-0.87]). Patient age and higher AF stroke risk score and AF bleeding risk scores were positively associated with both 180-day persistence and 360-day proportion of days covered. Conclusions Social risk domains, such as health literacy, may affect OAC adherence among patients with AF. Future studies should explore associations between social risk factors and nonadherence with greater geographic granularity.
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Boyd, Lisa M, Anthony Carmine Colavecchia, Kevin A Townsend, Laura Kmitch, Leah Broder, Rozelle R Hegeman-Dingle, Mohammad Ateya, Alan Lattimer, et al. (2023). Associations of Community and Individual Social Determinants of Health With Medication Adherence in Patients With Atrial Fibrillation: A Retrospective Cohort Study. Journal of the American Heart Association, 12(8). p. e026745. 10.1161/jaha.122.026745 Retrieved from https://hdl.handle.net/10161/29799.
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Laura Kmitch
Laura Kmitch is a PhD student in the Department of Population Health Sciences. Her research interests are varied and include health policy, healthcare interventions, program evaluation, implementation science, healthcare quality, access, social determinants of health, maternal and women's health, healthcare competition, and Real-World Evidence. She is passionate about applying health data to public health issues and developing incentives to effectively optimize patient interactions with the healthcare system. Recent projects have included investigating contraceptive use in all-payer claims data, evaluating the impact of a PCP-based pharmacist intervention on patients with uncontrolled hypertension and diabetes, supporting a community advisory board in a clinical trial focused on Children and Youth with Special Health Care Needs (CYSHCN), developing training case studies about pragmatic trials and employing Real-World Evidence, and a qualitative study of patient experiences with a produce prescription program.
Laura has worked extensively in the area of healthcare competition and has provided consulting support, performed economic and statistical analyses, and led teams in reviewing and analyzing large, complex data sets including claims data, EHR data, and administrative data. She has led the expert support teams for multiple hospital litigations, including Jefferson-Enstein, CVS-Aetna (Tunney Act hearing), Hershery-Pinnacle, and Phoebe Putney-Palmyra. As a manger a Bates White Economic Consulting, her experience also includes supporting testifying experts and private companies through all phases of government investigations and litigation. She also worked as a Research Analyst in the Federal Trade Commission’s Bureau of Economics, where worked on numerous merger investigations across a wide swath of industries, including hospitals, outpatient centers, physicians, biologics, pharmaceuticals, and retail. Most recently, Laura was the Director of Applied Analytics at a health technology startup focused on quantifying the impact of SDOH on health outcomes and utilization.
Her research has been mentioned in The New York Times and published in the Antitrust Law Journal and the Journal of Competition Law and Economics. She earned a MS in Population Health Sciences at Duke University as well as a BA in economics and a BS in business from the University of Maryland.
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