Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis

BMC Public Health

Dean T Eurich¹  Lisa Tjosvold¹  Daniala L Weir¹  Finlay A McAlister³  Gaetanne K Murphy² 

[1] Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta, Edmonton, Canada;2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB T6G 2E1, Canada;Division of General Internal Medicine, Department of Medicine, Medicine and Dentistry, University of Alberta, Edmonton, Canada

关键词: Drug utilization;    Medication adherence;    Urban population;    Rural population;    Cardiovascular diseases;   

Others  :  1129923
DOI  :  10.1186/1471-2458-14-544

 received in 2013-11-20, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Background

Rural residents face numerous barriers to healthcare access and studies suggest poorer health outcomes for rural patients. Therefore we undertook a systematic review to determine if cardiovascular medication utilization and adherence patterns differ for rural versus urban patients.

Methods

A comprehensive search of major electronic datasets was undertaken for controlled clinical trials and observational studies comparing utilization or adherence to cardiovascular medications in rural versus urban adults with cardiovascular disease or diabetes. Two reviewers independently identified citations, extracted data, and evaluated quality using the STROBE checklist. Risk estimates were abstracted and pooled where appropriate using random effects models. Methods and reporting were in accordance with MOOSE guidelines.

Results

Fifty-one studies were included of fair to good quality (median STROBE score 17.5). Although pooled unadjusted analyses suggested that patients in rural areas were less likely to receive evidence-based cardiovascular medications (23 studies, OR 0.88, 95% CI 0.79, 0.98), pooled data from 21 studies adjusted for potential confounders indicated no rural–urban differences (adjusted OR 1.02, 95% CI 0.91, 1.13). The high heterogeneity observed (I² = 97%) was partially explained by treatment setting (hospital, ambulatory care, or community-based sample), age, and disease. Adherence did not differ between urban versus rural patients (3 studies, OR 0.94, 95% CI 0.39, 2.27, I² = 91%).

Conclusions

We found no consistent differences in rates of cardiovascular medication utilization or adherence among adults with cardiovascular disease or diabetes living in rural versus urban settings. Higher quality evidence is needed to determine if differences truly exist between urban and rural patients in the use of, and adherence to, evidence-based medications.

【 授权许可】

   
2014 Murphy et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Krishna S, Gillespie KN, McBride TM: Diabetes burden and access to preventive care in the rural United States. J Rural Health 2010, 26:3-11.
• [2]Vanasse A, Courteau J, Cohen AA, Orzanco MG, Drouin C: Rural–urban disparities in the management and health issues of chronic diseases in Quebec (Canada) in the early 2000s. Rural Remote Health 2010, 10:1548.
• [3]Probst JC, Bellinger JD, Walsemann KM, Hardin J, Glover SH: Higher risk of death in rural blacks and whites than urbanites is related to lower incomes, education, and health coverage. Health Aff (Millwood) 2011, 30:1872-1879.
• [4]DesMeules M, Pong R, Lagace C, Heng D, Manuel D, Pitblado R, Bollman R, Guernsey J, Kazanjian A, Koren I: How Healthy Are Rural Canadians: An Assessment Of Their Health Status And Health Determinants. Ottawa, ON: Canadian Institute for Health Information; 2006. https://secure.cihi.ca/free_products/acknowledgements_rural_canadians_2006_report_e.pdf webcite. Accessed 2012 Sep 01
• [5]Gartner A, Farewell D, Roach P, Dunstan F: Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment. Soc Sci Med 2011, 72:1685-1694.
• [6]Smith KB, Humphreys JS, Wilson MGA: Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008, 16:56-66.
• [7]Jones A, Goza F: Rural, suburban and urban differences in the self-diagnosis of coronary heart disease in the United States. J Biosoc Sci 2008, 40:895-909.
• [8]Banegas JR, Rodriguez-Artalejo F, de la Cruz Troca JJ, Guallar-Castillon P, del Rey Calero J: Blood pressure in Spain: distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension 1998, 32:998-1002.
• [9]Psaltopoulou T, Orfanos P, Naska A, Lenas D, Trichopoulos D, Trichopoulou A: Prevalence, awareness, treatment and control of hypertension in a general population sample of 26,913 adults in the Greek EPIC study. Int J Epidemiol 2004, 33:1345-1352.
• [10]Gamble JM, Eurich DT, Ezekowitz JA, Kaul P, Quan H, McAlister FA: Patterns of care and outcomes differ for urban versus rural patients with newly diagnosed heart failure, even in a universal healthcare system. Circ Heart Fail 2011, 4:317-323.
• [11]Teng T-HK, Katzenellenbogen JM, Hung J, Knuiman M, Sanfilippo FM, Geelhoed E, Hobbs M, Thompson SC: Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage. BMJ Open 2014, 4:e004724.
• [12]Levin KA, Leyland AH: Urban–rural inequalities in ischemic heart disease in Scotland, 1981–1999. Am J Public Health 2006, 96:145-151.
• [13]Chondur R, Li SQ, Guthridge S, Lawton P: Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002–2006. Aust N Z J Public Health 2014, 38:117-121.
• [14]Goins RT, Williams KA, Carter MW, Spencer SM, Solovieva T: Perceived barriers to health care access among rural older adults: a qualitative study. J Rural Health 2005, 21:206-213.
• [15]Fordyce MA, Chen FM, Doescher MP, Hart LG: 2005 Physician Supply and Distribution in Rural Areas of the United States. Final Report. WWAMI Rural Health Research Center, University of Washington; 2007. Report No: 116. http://depts.washington.edu/uwrhrc/uploads/RHRC%20FR116%20Fordyce.pdf webcite
• [16]Aneja S, Ross JS, Wang Y, Matsumoto M, Rodgers GP, Bernheim SM, Rathore SS, Krumholz HM: US cardiologist workforce from 1995 to 2007: modest growth, lasting geographic maldistribution especially in rural areas. Health Aff (Millwood) 2011, 30:2301-2309.
• [17]Pong RW, DesMeules M, Heng D, Lagace C, Guernsey JR, Kazanjian A, Manuel D, Pitblado JR, Bollman R, Koren I, Dressler MP, Wang F, Luo W: Patterns of health service utilization in rural Canada. Chronic Dis Can 2011, 31(Supp 1):1-36.
• [18]Sibley LM, Weiner JP: An evaluation of access to health care services along the rural–urban continuum in Canada. BMC Health Serv Res 2011, 11:20. BioMed Central Full Text
• [19]Klepser DG, Xu L, Ullrich F, Mueller KJ: Trends in community pharmacy counts and closures before and after the implementation of Medicare part D. J Rural Health 2011, 27:168-175.
• [20]Grymonpre RE, Hawranik PG: Rural residence and prescription medication use by community-dwelling older adults: a review of the literature. J Rural Health 2008, 24:203-209.
• [21]Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ: Heart disease and stroke statistics–2012 update: a report from the American heart association. Circulation 2012, 125:e2-e220.
• [22]Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.
• [23]von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008, 61:344-349.
• [24]Altman DG, Bland JM: How to obtain the confidence interval from a P value. BMJ 2011, 343:d2090.
• [25]Review Manager (RevMan). [Computer program]. Version 5.1: Review Manager (RevMan). [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2011.
• [26]Borgenstein M, Hedges LV, Higgins JPT, Rothstein HR: Multiple outcomes or time-points within a study. In Introduction to Meta-Analysis. Chichester, UK: John Wiley & Sons; 2009:225-238.
• [27]Ambardekar AV, Fonarow GC, Dai D, Peterson ED, Hernandez AF, Cannon CP, Krantz MJ: Quality of care and in-hospital outcomes in patients with coronary heart disease in rural and urban hospitals (from get with the guidelines-coronary artery disease program). Am J Cardiol 2010, 105:139-143.
• [28]Andrus MR, Kelley KW, Murphey LM, Herndon KC: A comparison of diabetes care in rural and urban medical clinics in Alabama. J Community Health 2004, 29:29-44.
• [29]Asghari S, Courteau J, Drouin C, Gregoire JP, Carpentier AC, Paquet M, Vanasse A: Adherence to vascular protection drugs in diabetic patients in Quebec: a population-based analysis. Diab Vasc Dis Res 2010, 7:167-171.
• [30]Baldwin LM, Chan L, Andrilla CH, Huff ED, Hart LG: Quality of care for myocardial infarction in rural and urban hospitals. J Rural Health 2010, 26:51-57.
• [31]Baldwin LM, MacLehose RF, Hart LG, Beaver SK, Every N, Chan L: Quality of care for acute myocardial infarction in rural and urban US hospitals. J Rural Health 2004, 20:99-108.
• [32]Bradley EH, Herrin J, Mattera JA, Holmboe ES, Wang Y, Frederick P, Roumanis SA, Radford MJ, Krumholz HM: Hospital-level performance improvement: beta-blocker use after acute myocardial infarction. Med Care 2004, 42:591-599.
• [33]Bradley EH, Herrin J, Mattera JA, Holmboe ES, Wang Y, Frederick P, Roumanis SA, Radford MJ, Krumholz HM: Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction. Med Care 2005, 43:282-292.
• [34]Byrne M, Murphy AW, Walsh JC, Shryane E, McGroarty M, Kelleher CC: A cross-sectional study of secondary cardiac care in general practice: impact of personal and practice characteristics. Fam Pract 2006, 23:295-302.
• [35]Clark RA, Eckert KA, Stewart S, Phillips SM, Yallop JJ, Tonkin AM, Krum H: Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study. Med J Aust 2007, 186:441-445.
• [36]Colleran KM, Richards A, Shafer K: Disparities in cardiovascular disease risk and treatment: demographic comparison. J Investig Med 2007, 55:415-422.
• [37]Czarnecka D, Pawelec M, Kopacz E, Kloch M: Socioeconomical status of life and regularity of intake of medicines among hypertensive patients. Przegl Lek 2006, 63:633-636.
• [38]de Oliveira-Martins S, Oliveira T, Gomes JJF, Caramona M, Cabrita J: Factors associated with arterial hypertension in pharmacy users in Portugal. Rev Saude Publica 2011, 45:136-144.
• [39]Dellasega C, Orwig D, Ahern F, Lenz E: Postdischarge medication use of elderly cardiac patients from urban and rural locations. J Gerontol A Biol Sci Med Sci 1999, 54:M514-M520.
• [40]DeWilde S, Carey IM, Bremner SA, Richards N, Hilton SR, Cook DG: Evolution of statin prescribing 1994–2001: a case of agism but not of sexism? Heart 2003, 89:417-421.
• [41]DeWilde S, Carey IM, Emmas C, Richards N, Cook DG: Trends in the prevalence of diagnosed atrial fibrillation, its treatment with anticoagulation and predictors of such treatment in UK primary care. Heart 2006, 92:1064-1070.
• [42]DiMartino LD, Shea AM, Hernandez AF, Curtis LH: Use of guideline-recommended therapies for heart failure in the medicare population. Clin Cardiol 2010, 33:400-405.
• [43]Ellis C, Grubaugh AL, Egede LE: The effect of minority status and rural residence on actions to control high blood pressure in the U.S. Public Health Rep 2010, 125:801-809.
• [44]Flaker GC, McGowan DJ, Boechler M, Fortune G, Gage B: Underutilization of antithrombotic therapy in elderly rural patients with atrial fibrillation. Am Heart J 1999, 137:307-312.
• [45]Fonarow GC, French WJ, Frederick PD: Trends in the use of lipid-lowering medications at discharge in patients with acute myocardial infarction: 1998 to 2006. Am Heart J 2009, 157:185-194.
• [46]Friedman O, McAlister FA, Yun L, Campbell NR, Tu K: Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario. Am J Med 2010, 123:173-181.
• [47]Funkhouser E, Houston TK, Levine DA, Richman J, Allison JJ, Kiefe CI: Physician and patient influences on provider performance: beta-blockers in postmyocardial infarction management in the MI-Plus study. Circ Cardiovasc Qual Outcomes 2011, 4:99-106.
• [48]Gage BF, Boechler M, Doggette AL, Fortune G, Flaker GC, Rich MW, Radford MJ: Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke 2000, 31:822-827.
• [49]Goldman LE, Dudley RA: United States rural hospital quality in the hospital compare database-accounting for hospital characteristics. Health Policy 2008, 87:112-127.
• [50]Hense HW, Tennis P: Changing patterns of antihypertensive drug use in a German population between 1984 and 1987. Results of a population based cohort study in the federal republic of Germany. Eur J Clin Pharmacol 1990, 39:1-7.
• [51]Hicks PC, Bublitz Emsermann C, Westfall JM, Parnes B: Comparison of HTN management in patients with diabetes between rural and urban primary care clinics in Northeastern Colorado - a report from SNOCAP. Rural Remote Health 2010, 10:1-11.
• [52]Huttin C: The role of different types of health insurance on access and utilization of antihypertensive drugs: an empirical study in a US hypertensive population. Dis Manag Health Outcome 2002, 10:419-430.
• [53]Ko DT, Mamdani M, Alter DA: Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 2004, 291:1864-1870.
• [54]Lutfiyya MN, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS: A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. Int J Qual Health Care 2007, 19:141-149.
• [55]Ma J, Stafford RS: Screening, treatment, and control of hypertension in US private physician offices, 2003–2004. Hypertension 2008, 51:1275-1281.
• [56]Maio V, Marino M, Robeson M, Gagne JJ: Beta-blocker initiation and adherence after hospitalization for acute myocardial infarction. Eur J Cardiovasc Prev Rehabil 2011, 18:438-445.
• [57]Majumdar SR, Gurwitz JH, Soumerai SB: Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease. J Gen Intern Med 1999, 14:711-717.
• [58]Majumdar SR, Inui TS, Gurwitz JH, Gillman MW, McLaughlin TJ, Soumerai SB: Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction. J Gen Intern Med 2001, 16:351-359.
• [59]Munschauer FE, Priore RL, Hens M, Castilone A: Thromboembolism prophylaxis in chronic atrial fibrillation: practice patterns in community and tertiary-care hospitals. Stroke 1997, 28:72-76.
• [60]Nguyen KX, Marinac JS, Sun C: Aspirin for primary prevention in patients with diabetes mellitus. Fam Med 2005, 37:112-117.
• [61]Niska R, Han B: Statins for secondary cardiovascular disease prevention for older primary care patients. J Natl Med Assoc 2009, 101:705-710.
• [62]Niska R, Han B: Anticoagulation for patients with atrial fibrillation in ambulatory care settings. J Am Board Fam Med 2009, 22:299-306.
• [63]Obisesan TO, Vargas CM, Gillum RF: Geographic variation in stroke risk in the United States - region, urbanization, and hypertension in the third national health and nutrition examination survey. Stroke 2000, 31:19-25.
• [64]Perez-Fernandez R, Marino AF, Cadarso-Suarez C, Botana MA, Tome MA, Solache I, Rego-Iraeta A, Mato AJ: Prevalence, awareness, treatment and control of hypertension in Galicia (Spain) and association with related diseases. J Hum Hypertens 2007, 21:366-373.
• [65]Pittrow D, Kirch W, Bramlage P, Lehnert H, Hofler M, Unger T, Sharma AM, Wittchen HU: Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol 2004, 60:135-142.
• [66]Rice T, Lavarreda SA, Ponce NA, Brown ER: The impact of private and public health insurance on medication use for adults with chronic diseases. Med Care Res Rev 2005, 62:231-249.
• [67]Rowan SB, Bailey DN, Bublitz CE, Anderson RJ: Trends in anticoagulation for atrial fibrillation in the U.S.: an analysis of the national ambulatory medical care survey database. J Am Coll Cardiol 2007, 49:1561-1565.
• [68]Sheikh K, Bullock C: Urban–rural differences in the quality of care for medicare patients with acute myocardial infarction. Arch Intern Med 2001, 161:737-743.
• [69]Strom JL, Lynch CP, Egede LE: Rural/urban variations in diabetes self-care and quality of care in a national sample of US adults with diabetes. Diabetes Educ 2011, 37:254-262.
• [70]Tuesca-Molina R, Guallar-Castillon P, Banegas-Banegas JR, Graciani-Perez Regadera A: Determinants of the adherence to therapeutic plan in elderly Spaniards, over 60 years of age. Gac Sanit 2006, 20:220-227.
• [71]Wan Q, Harris MF, Davies GP, Jayasinghe UW, Flack J, Georgiou A, Burns JR, Penn DL: Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas. Int J Clin Pract 2008, 62:53-58.
• [72]Williams SC, Koss RG, Morton DJ, Schmaltz SP, Loeb JM: Case volume and hospital compliance with evidence-based processes of care. Int J Qual Health Care 2008, 20:79-87.
• [73]Wu JR, Moser DK, Rayens MK, De Jong MJ, Chung ML, Riegel B, Lennie TA: Rurality and event-free survival in patients with heart failure. Heart Lung 2010, 39:512-520.
• [74]Yiannakopoulou EC, Papadopulos JS, Cokkinos DV, Mountokalakis TD: Adherence to antihypertensive treatment: a critical factor for blood pressure control. Eur J Cardiovasc Prev Rehabil 2005, 12:243-249.
• [75]Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, Gupta R, Kelishadi R, Iqbal R, Avezum A, Kruger A, Kutty R, Lanas F, Lisheng L, Wei L, Lopez-Jaramillo P, Oguz A, Rahman O, Swidan H, Yusoff K, Zatonski W, Rosengren A, Teo KK: Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011, 378:1231-1243.
• [76]Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK: Medication compliance and persistence: terminology and definitions. Value Health 2008, 11:44-47.
• [77]Kwan J, Razzaq A, Leiter LA, Lillie D, Hux JE: Low socioeconomic status and absence of supplemental health insurance as barriers to diabetes care access and utilization. Can J Diabetes 2008, 32:174-181.
• [78]Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA: A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006, 333:15.