Abstract 12703: Hypertension in a Developmentally Disabled Population: Medication Use and Adherence Patterns
Background: Adults with developmental disabilities (DD) have high prevalence of coronary artery disease risk factors such as hypertension (HT), as well as impediments to optimal diagnosis and management. Little data exists regarding HT treatment in this population. To address this, we analyzed antihypertensive medication (AM) use and adherence patterns in a Kansas Medicaid cohort.
Methods: Using Kansas Medicaid data, we linked a listing of adults (18–64 years) with DD to paid claims. We screened outpatient and inpatient claims for HT diagnosis codes (401–405) from 7/1/05 to 8/31/06, followed by review of prescription records of AM use and adherence from 9/1/06 to 8/31/07. Dual (Medicare) eligible patients were excluded. Adherence was calculated as proportion of days covered (PDC).
Results: Of 3,079 eligible subjects, 280 (9%;) had claims for HT: 51% male, mean age 42 yrs ±13, and 81% Caucasian. Most of these 280 (72%) had claims for at least 1 AM: 57% required <ul;2>><ul;0> 2 AM. ACEI/ARBs were the most commonly overall prescribed class (65%) followed by diuretics (50%), β-blockers (BB) (34%), and calcium channel blockers (CCB) (26%). ACEI/ARBs were also most commonly used monotherapy (21%) followed by diuretics (10%), BB (9%) and CCBs (4%). Mean PDCs by class ranged from 0.622 to 0.693 indicating that subjects had obtained AM for 2/3 of the monitoring year: 55% had a PDC ≥ 0.80, a common cut point for adherence. Younger individuals were more likely to be adherent (age ≥ 50 yrs as referent group): 18–29 yrs (AOR = 4.48; 95% CI, 2.02–9.97) and 30–49 yrs (AOR = 2.69; 95% CI, 1.39–5.23), but adherence was not significantly associated with comorbid conditions, gender, or race.
Conclusions: Of our cohort of adults with DD, 9% had HT of whom 72% submitted claims for AMs. This claims-based approach likely underestimates the true rate of HT. With mean age 42 yrs, most of these individuals will require long-term AM. A substantial proportion of subjects had inconsistent AM use suggesting suboptimal therapy. The association between younger ages and higher adherence may reflect better community-based support for younger adults. Further work is needed to identify barriers to optimal care and the outcomes of gaps in medication coverage for this vulnerable population.
- © 2010 by American Heart Association, Inc.