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. 2021 Jan;39(1):153-161.
doi: 10.1097/HJH.0000000000002590.

Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension

Erin Peacock  1 , Cara Joyce  2 , Leslie S Craig  1 , Zachary Lenane  3 , Elizabeth W Holt  4 , Paul Muntner  5 , Marie Krousel-Wood  1   6   7
Affiliations
Free PMC article

Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension

Erin Peacock et al. J Hypertens. 2021 Jan.
Free PMC article

Abstract

Objective: The aim of this study was to determine the association of low antihypertensive medication adherence with decline in health-related quality of life (HRQOL) over 1 year.

Methods: We used data from older men and women with hypertension (n = 1525) enrolled in the Cohort Study of Medication Adherence among Older Adults. Adherence was measured using the validated self-report four-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) (low adherence = score ≥1) and prescription refill-based proportion of days covered (PDC) (low adherence = PDC < 0.80). We defined decline in HRQOL as a decrease in Mental Component Summary (MCS) or Physical Component Summary (PCS) score (from the RAND 36-Item Health Survey 1.0 administered at two time points - at the time of adherence assessment and 1 year later) equivalent to the minimal important difference (MID) for each respective summary score, calculated as the average of MID estimates derived from distribution and anchor-based approaches.

Results: The prevalence of low adherence was 38.6% using the K-Wood-MAS-4 and 23.9% using PDC. On the basis of mean MID estimates of 4.40 for MCS and 5.16 for PCS, 21.8 and 25.2% of participants experienced a decline in MCS and PCS, respectively, over 1 year. Low adherence was associated with a decline in MCS for K-Wood-MAS-4 [prevalence ratio = 1.32, 95% confidence interval (95% CI) 1.08-1.62, P = 0.008], but not PDC (prevalence ratio = 1.17, 95% CI 0.94-1.47, P = 0.168). Low adherence was not associated with decline in PCS (K-Wood-MAS-4: prevalence ratio = 0.95, 95% CI 0.79-1.16; PDC: prevalence ratio = 1.10, 95% CI 0.90-1.35).

Conclusion: Low self-report medication adherence is associated with decline in mental HRQOL over 1 year in older adults with hypertension.

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Conflict of interest statement

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

P.M. receives grant support from Amgen Inc. for work unrelated to this manuscript. For the remaining authors, no potential conflicts of interest were declared.

Figures

FIGURE 1
FIGURE 1
Adjusted prevalence ratios and 95% confidence intervals for decline in health-related quality of life (MCS and PCS), overall and stratified by age, sex and race. Reference category for all models: high adherence. CI, confidence interval; K-Wood-MAS-4, Krousel-Wood medication adherence scale; MCS, Mental Component Summary; PCS, Physical Component Summary; PDC, proportion of days covered; PR, prevalence ratio. ∗∗P < 0.01.
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