Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients

Yeon-Yong Kim,Hee-Jin Kang,Sang Min Park,Jin-Seok Lee

doi:10.1038/s41598-018-30740-y

Abstract

This study determined the effects of anti-diabetic medication adherence on the long-term all-cause mortality and hospitalization for cerebrovascular disease and myocardial infarction among newly diagnosed patients. The study used retrospective cohort from the National Health Insurance Service. Study participants were 65,076 newly diagnosed type 2 diabetes mellitus patients aged ≥40 years. The medication adherence was evaluated from the proportion of days covered (PDC) between 2006 and 2007. Outcome variables were mortality, newly diagnosed cerebrovascular disease (CVD) and myocardial infarction (MI) in 2008–2017. Cox-proportional hazard regression analysis was performed. After adjusting for sex, age, monthly contribution, insurance type, medical institution type, Charlson comorbidity index score, disability, hypertension, and active ingredients of oral hypoglycemic agents, the adjusted hazard ratio (aHR) for all-cause-mortality of the lowest PDC group (<0.20) was 1.45 (95% confidence interval [CI] = 1.36–1.54) as compared to the highest PDC (≥0.8). The aHR for all-cause-mortality associated with PDC levels of 0.60–0.79, 0.40–0.59, and 0.20–0.39 were 1.19, 1.26, and 1.34, respectively (Ptrend < 0.001). Compared to the highest PDC group, diabetic patients with the lowest PDC had elevated risk for CVD (aHR = 1.41; 95% CI = 1.30–1.52; Ptrend < 0.001). Improving anti-diabetic medication adherence among newly diagnosed type 2 diabetes mellitus patients is essential to the reduce risk for cardiovascular disease and long-term all-cause mortality.

Highlights

Continuity of care, a provider factor, and medication adherence, a patient factor, in chronic disease management affect both the health outcome and the healthcare expenditure in chronic disease management[1,2,3]
This study determined the effects of medication adherence on cardiovascular disease-related hospitalization and long-term all-cause mortality among newly diagnosed type 2 diabetic patients
The National Health Information Database (NHID) includes healthcare utilization data based on claims data, that include the entire population of South Korea; and eligibility data containing socioeconomic status, such as insurance type and monthly contributions based on the income level

Summary

Methods

The NHID includes healthcare utilization data based on claims data, that include the entire population of South Korea; and eligibility data containing socioeconomic status, such as insurance type and monthly contributions based on the income level. We used the same scoring criteria that used in a study by Steffen et al for comorbidities[19] Socioeconomic status variables, such as age, sex, disability, insurance type, and monthly contributions in 2006, were used as independent variables from the eligibility data section of the NHID. The medication adherence of newly diagnosed patients was evaluated, using the healthcare utilization database section of the NHID between 2006 and 2007. The information of the main medical institution type (primary, secondary, and tertiary level institution), the PDC, and active ingredients of oral hypoglycemic agents were collected from the healthcare utilization data for the intervention period (2006–2007).

Results

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