A data-driven typology of asthma medication adherence using cluster analysis

Abstract

Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an intervention study of electronic inhaler monitoring devices, comprising 211 patients yielding 35,161 person-days of data. Five adherence measures were extracted: the percentage of doses taken, the percentage of days on which zero doses were taken, the percentage of days on which both doses were taken, the number of treatment intermissions per 100 study days, and the duration of treatment intermissions per 100 study days. We applied principal component analysis on the measures and subsequently applied k-means to determine cluster membership. Decision trees identified the measure that could predict cluster assignment with the highest accuracy, increasing interpretability and increasing clinical utility. We demonstrate the use of adherence measures towards a three-group categorization of medication non-adherence, which succinctly describes the diversity of patient medication taking patterns in asthma. The percentage of prescribed doses taken during the study contributed to the prediction of cluster assignment most accurately (84% in out-of-sample data).

Figure 1

Histogram of the number of treatment intermissions (continuous abstinence of 5 days or longer) per person during study period.

Figure 2

Decision tree for estimating exploratory adherence clusters.

Figure 3

Boxplots of the five adherence measures by tree-derived groups. (A) Percentage of doses taken, (B) Percentage of days zero doses taken, (C) Percentage of days both doses taken, (D) Number of treatment intermissions per 100 study days, (E) Duration of treatment intermissions per 100 study days.