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Review
. 2006 Jul 1;333(7557):15.
doi: 10.1136/bmj.38875.675486.55. Epub 2006 Jun 21.

A meta-analysis of the association between adherence to drug therapy and mortality

Scot H Simpson  1 , Dean T Eurich, Sumit R Majumdar, Rajdeep S Padwal, Ross T Tsuyuki, Janice Varney, Jeffrey A Johnson
Affiliations
Review

A meta-analysis of the association between adherence to drug therapy and mortality

Scot H Simpson et al. BMJ. .

Abstract

Objective: To evaluate the relation between adherence to drug therapy, including placebo, and mortality.

Design: Meta-analysis of observational studies.

Data sources: Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality.

Results: Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11).

Conclusion: Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.

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Figures

Fig 1
Fig 1
Flow of articles identified and studies included in review
Fig 2
Fig 2
Association between adherence to placebo and mortality
Fig 3
Fig 3
Association between adherence to harmful or beneficial drug therapy and mortality
See this image and copyright information in PMC

Comment in

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