PCV39 Association between Social Determinants of Health, Heathcare Resource Utilization, Medication Adherence, and Medication Persistence Among Patients with Hypertension

Abstract

The objective of this study was to assess the relationship between social determinants of health (SDoH) characteristics, healthcare resource utilization (HCRU), adherence, and persistence among patients with hypertension. Data from the 2019 National Health and Wellness Survey were linked to medical and prescription claims from Komodo Health. Participants age≥18 who self-reported a physician-diagnoses of hypertension and had continuous medical and prescription eligibility 1/1/2019-12/31/2019 were included. HCRU outcomes include physician-office visits, outpatient visits, emergency room (ER) visits, hospitalizations, and antihypertensive utilization including beta-blockers (BB), calcium channel-blockers (CCB), and renin-angiotensin system antagonists (RASA). Adherence was calculated by class using pharmacy quality alliance proportion of days covered (PDC), with adherent defined as PDC≥80%. Nonpersistence was defined as a gap in therapy ≥30 days or discontinuation ≥30 days prior to observation period end, and was calculated by class among participants with ≥1 prescription claim. Statistical testing was used to assess differences in outcomes when stratified by SDoH (e.g., gender, race/ethnicity, income). 1763 eligible patients with hypertension were analyzed. Statistically-significant differences in HCRU were found for all SDoH characteristics, including: higher proportion of Hispanic patients with a physician-office visit (85.2%;p=0.038) and a higher proportion of non-Hispanic/black patients with an all-cause ER visit (31.8%;p<0.0001) or hospitalization (11.8%;p=0.037). 60.1% (N=1059) of all patients had ≥1 antihypertensive claim, with higher proportions seen in non-Hispanic/Black (65.9%;p=0.032) or patients with an income $25000-$49000 (67.6%;p<0.001). A larger proportion of Hispanic patients were nonpersistent (72.2%p<0.01) or nonadherent (70.6%;p=0.001) to CCBs, and nonadherent to RASAs (60.5%;p<0.05). Among patents with hypertension significant associations exist between SDoH characteristics, HCRU, adherence, and persistence. Further research is needed to understand why Hispanics are less persistent to their antihypertensives while having more frequent contacts with their physicians. A better understanding of the role SDoH plays in the management of hypertension could improve hypertension control and reduce healthcare costs.