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Eunjung Choo 1 Article
A comparison of methods for the measurement of adherence to antihypertensive multidrug therapy and the clinical consequences: a retrospective cohort study using the Korean nationwide claims database
Minji Jung, Eunjung Choo, Sukhyang Lee
Epidemiol Health. 2023;45:e2023050.   Published online May 1, 2023
DOI: https://doi.org/10.4178/epih.e2023050
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Abstract
OBJECTIVES
In observational studies, the methods used to measure medication adherence may affect assessments of the clinical outcomes of drug therapy. This study estimated medication adherence to multidrug therapy in patients with hypertension using different measurement methods and compared their impacts on clinical outcomes.
METHODS
This was a retrospective cohort study using the Korean National Health Insurance Service–National Sample Cohort database (2006-2015). Adults diagnosed with hypertension who initiated multidrug antihypertensive therapy in the index year 2007 were included. Adherence was defined as over 80% compliance. Adherence to multidrug antihypertensive therapy was measured in 3 ways using the proportion of days covered (PDC) with 2 approaches to the end-date of the study observations: PDC with at least one drug (PDC<sub>with≥1</sub>), PDC with a duration weighted mean (PDC<sub>wm</sub>), and the daily polypharmacy possession ratio (DPPR). The primary clinical outcome was a composite of cardiovascular and cerebrovascular disease-specific hospitalizations or all-cause mortality.
RESULTS
In total, 4,226 patients who initiated multidrug therapy for hypertension were identified. The mean adherence according to the predefined measurements varied from 72.7% to 79.8%. Non-adherence was associated with an increased risk of a primary outcome. The hazard ratios (95% confidence intervals, CIs) primary outcomes varied from 1.38 (95% CI, 1.19 to 1.59) to 1.44 (95% CI, 1.25 to 1.67).
CONCLUSIONS
Non-adherence to multidrug antihypertensive therapy was significantly associated with an increased risk of a primary clinical outcome. Across the varying estimates based on different methods, medication adherence levels were similar. These findings may provide evidence to support decision-making when assessing medication adherence.
Summary
Korean summary
- 여섯 가지 다중약물 순응도 평가 방법을 적용했을 때, 고혈압제 병용 요법 순응도는 70~80%으로 유사한 결과값을 보였다. - 순응군 대비 비순응군에서 심혈관질환 관련 입원 및 전체 사망 위험 증가가 1.4배 높았다.
Key Message
-In Korea, adherence to multidrug antihypertensive therapy was approximately 70~80% across the six measurements. -Similar impacts of adherence to multidrug antihypertensive therapy upon the clinical consequences with a 4-folds increased risk across the six measurements. -We provide evidence for decision-making of applying adherence measurement in observational analysis.

Epidemiol Health : Epidemiology and Health