Abstract 10805: Income and Antiplatelet Adherence Following Acute Coronary Syndrome: An Administrative Claims Analysis

Abstract

Introduction: Income and social resources are associated with cardiovascular health and outcomes. We examined income and medication adherence following acute coronary syndromes (ACS). We hypothesized that following percutaneous coronary intervention (PCI), individuals with lower income would have lower adherence to antiplatelet agents than higher income referents. Methods: We employed administrative claims of commercially insured and Medicare Advantage beneficiaries (Optum's de-identified Clinformatics® Data Mart Database) with incident ST- and non-ST elevation myocardial infarction from 2017-19. We collected data on age, sex, race, education, and covariates (medications, healthcare visits, insurance type, copay, antiplatelet type, and Elixhauser Comorbidity Index conditions). We compared antiplatelet adherence, measured with proportion of days covered (PDC) using up to 12 months of pharmacy claims, across income categories (<$40K; $40-49K; $50-59K; $60-74K; $75-99K; and ≥$100K). Our multivariable-adjusted regression models determined odds of non-adherence (PDC<80%) with the highest income category as referent. Results: Our dataset included 31,272 individuals (age 72.5 ±11.9, 34.3% women, 22.6% non-White) who presented with ACS and underwent PCI. We observed graded, decreased antiplatelet adherence across income categories (Figure): rates of PDC≥80% decreased with successively lower income, from 84.3% (≥$100K) to 73.1% (<$40K). Individuals with income <$40K had 1.6-fold higher odds of non-adherence (95% CI, 1.43-1.75) compared to those with income ≥$100K after multivariable adjustment. Conclusions: Lower income is associated with lower adherence to antiplatelet agents following PCI for ACS. These results support consideration of income and long-term barriers to medication access as part of strategies to address adherence.