Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aims: The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods: Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). Results: During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions: Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

Original languageEnglish
Pages (from-to)227-235
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Volume85
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • discontinuation
  • nonadherence
  • older adults
  • persistence
  • statins

Cite this

@article{d6ab7ce3a9c04720a06947006dc9784c,
title = "Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study",
abstract = "Aims: The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods: Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). Results: During the one-year follow-up, 55.1{\%} were nonadherent (concessional 52.6{\%}; general beneficiaries 64.2{\%}) and 44.7{\%} discontinued statins (concessional 43.1{\%}; general beneficiaries 50.4{\%}). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95{\%} confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions: Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.",
keywords = "discontinuation, nonadherence, older adults, persistence, statins",
author = "Richard Ofori-Asenso and Jenni Ilom{\"a}ki and Mark Tacey and Si Si and Curtis, {Andrea J.} and Ella Zomer and Bell, {J. Simon} and Sophia Zoungas and Danny Liew",
year = "2019",
month = "1",
doi = "10.1111/bcp.13797",
language = "English",
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pages = "227--235",
journal = "British Journal of Clinical Pharmacology",
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Predictors of first-year nonadherence and discontinuation of statins among older adults : a retrospective cohort study. / Ofori-Asenso, Richard; Ilomäki, Jenni; Tacey, Mark; Si, Si; Curtis, Andrea J.; Zomer, Ella; Bell, J. Simon; Zoungas, Sophia; Liew, Danny.

In: British Journal of Clinical Pharmacology, Vol. 85, No. 1, 01.2019, p. 227-235.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predictors of first-year nonadherence and discontinuation of statins among older adults

T2 - a retrospective cohort study

AU - Ofori-Asenso, Richard

AU - Ilomäki, Jenni

AU - Tacey, Mark

AU - Si, Si

AU - Curtis, Andrea J.

AU - Zomer, Ella

AU - Bell, J. Simon

AU - Zoungas, Sophia

AU - Liew, Danny

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N2 - Aims: The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods: Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). Results: During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions: Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

AB - Aims: The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods: Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). Results: During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions: Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

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KW - older adults

KW - persistence

KW - statins

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