TY - JOUR
T1 - Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South
AU - Cummings, Doyle M.
AU - Wu, Jia Rong
AU - Cene, Crystal
AU - Halladay, Jacquie
AU - Donahue, Katrina E.
AU - Hinderliter, Alan
AU - Miller, Cassandra
AU - Garcia, Beverly
AU - Penn, Dolly
AU - Tillman, Jim
AU - Dewalt, Darren
N1 - Publisher Copyright:
© 2016 National Rural Health Association.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Purpose: Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. Methods: Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. Findings: Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. Conclusions: Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities.
AB - Purpose: Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. Methods: Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. Findings: Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. Conclusions: Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities.
KW - Health disparities
KW - Health services research
KW - Hypertension
KW - Medication adherence
KW - Social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=84950294169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84950294169&partnerID=8YFLogxK
U2 - 10.1111/jrh.12138
DO - 10.1111/jrh.12138
M3 - Article
C2 - 26334761
AN - SCOPUS:84950294169
SN - 0890-765X
VL - 32
SP - 156
EP - 163
JO - Journal of Rural Health
JF - Journal of Rural Health
IS - 2
ER -