Browsing by Subject "lääkemääräysten noudattaminen"

Non-adherence to drug therapy is a serious public health problem that increases the risk of disease and mortality. Despite long-term adherence to statins is a key element in preventing cardiovascular disease (CVD) and myocardial infarction (MI), previous studies have shown that the level of adherence drops already within the first six months of treatment. Risk factors for non-adherence are older age, comorbidities, being nonmarried and a lower socioeconomic position. Less is known about the role of living arrangements in non-adherence. The aim of this study is to provide new information on the association between living alone and non-adherence to statin drug therapy after MI, and analyze whether household income mediates or moderates the association. The analysis utilizes a register-based dataset consisting of an 11 % sample of the Finnish population with an 80 % oversample of people who died between 1988 and 2007. The study population included patients with first hospitalization for MI and at least one purchase of statins. Individuals are followed for five years after MI and censored at the time of emigration, moving to institutional care, a recurring MI or death. General estimating equations (GEE) method, an application of logistic regression for correlated data, is used to analyze the associations. All analyses are conducted separately for men and women and are adjusted for age and year of medicine purchase. Non-adherence to statin drug therapy increased over the first four years after MI, and a sharp increase occurred after the first three months of follow-up. Among men, the risk of non-adherence was higher for those living alone (odds ratio [OR] =1.24, 95% confidence interval [CI] 1.14–1.36) and those with lower incomes (OR=1.28, 95% CI 1.14-1.42 for lowest quintile). Adjustment for income somewhat attenuated the risk associated with living alone, while adjusting for education and labor market status had a negligible effect. Living alone predicted non-adherence similarly across all income groups among men. No statistically significant associations emerged among women. In conclusion, men living alone have a higher risk of being non-adherent compared to men living with others. Lack of spousal support and generally poorer health behaviors can be mechanisms behind the observed association. Health care professionals should pay special attention to men living alone to identify patients in high risk of non-adherence. By improving medication adherence, lives and unnecessary healthcare costs can be saved.