Abstract 153: Predictors of Aspirin Nonadherence in Adults with Prior Myocardial Infarction

Abstract

Background: Medication nonadherence is an alarming public health concern due to its effect on both individual treatment success and overall health care costs. In this study, we sought to identify the predictors of aspirin nonadherence in adults with prior myocardial infarction (MI). Methods: The 2017 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 2,173 adults with prior MI who had reported the presence or absence of regular aspirin use. Demographic and clinical history were recorded and compared in individuals reporting the presence versus absence of aspirin adherence (defined as self-reported regular use of aspirin). Results: Among 2,173 adults with prior MI, 1623 (74.7%) reported adherence to aspirin while 550 (25.3%) reported aspirin nonadherence. Adults with aspirin nonadherence were younger, and more likely to be female (50.2% vs. 40.8%, p<0.001), Black (16.3% vs. 12.1%, p<0.001), and of Hispanic ethnicity (21.0% vs. 10.0%, p<0.001). They were also less likely to have health insurance (92.1% vs. 95.2%, p=0.007) or own a home (62.6% vs. 72.3%, p<0.001), and had lower annual incomes. Adults with aspirin nonadherence were noted to have less frequent medical checkups and lower rates of multiple comorbidities including diabetes mellitus (33.9% vs. 39.9%, p=0.012), hypertension (72.8% vs. 78.0%, p=0.013), hyperlipidemia (61.7% vs. 70.3%, p<0.001), and obesity (39.4% vs. 41.9%, p=0.013). In multivariate analysis, independent predictors of aspirin nonadherence in this population included female sex (adjusted odds ratio (OR) [95% confidence interval]) = 1.45 [1.14-1.83], Black race (1.64 [1.19-2.26]), Hispanic ethnicity (2.27 [1.61-3.21]), current employment (1.74 [1.28-2.36]), and absence of homeowner status (0.71 [0.55-0.93]). Conclusion: In this observational contemporary study of adults with prior MI, predictors of aspirin nonadherence include female sex, Black race, Hispanic ethnicity, employment status, and homeowner status. Appropriately identifying demographics of patients that may have barriers to adherence, especially at the time of initial medication recommendations, may help physicians to identify those at heightened risk for future nonadherence, thus allowing for timely and targeted educational and social work interventions to achieve treatment success through improved health outcomes and lower health care costs.