Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 May;36(5):1359-1370.
doi: 10.1007/s11606-020-06447-0. Epub 2021 Jan 29.

The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis

Marcee E Wilder  1 , Paige Kulie  2 , Caroline Jensen  3 , Paul Levett  4 , Janice Blanchard  2 , Luis W Dominguez  2 , Maria Portela  2 , Aneil Srivastava  2 , Yixuan Li  5 , Melissa L McCarthy  2   5
Affiliations
Meta-Analysis

The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis

Marcee E Wilder et al. J Gen Intern Med. 2021 May.

Abstract

Background: Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA.

Methods: We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively.

Results: A total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42-0.7), housing instability (aOR = 0.64; 95% CI 0.44-0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65-0.88) and medication adherence.

Discussion: Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.

Keywords: medication adherence; social determinants of health.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Pooled adjusted odds ratios.
Figure 3
Figure 3
Pooled unadjusted odds ratios.
See this image and copyright information in PMC

References

    1. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288(22):2880–3. doi: 10.1001/jama.288.22.2880. - DOI - PubMed
    1. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794–811. doi: 10.1097/00005650-200209000-00009. - DOI - PubMed
    1. World Health Organization., Sabaté E. Adherence to long-term therapies : evidence for action. World Health Organization; 2003:xv, 198 p.
    1. Agarwal R, Gupta A, Fendrick AM. Value-Based Insurance Design Improves Medication Adherence Without An Increase In Total Health Care Spending. Health Aff (Millwood) 2018;37(7):1057–1064. doi: 10.1377/hlthaff.2017.1633. - DOI - PubMed
    1. Mishuk AU, Fasina I, Qian J. Impact of U.S. federal and state generic drug policies on drug use, spending, and patient outcomes - A systematic review. Res Social Adm Pharm. 2019; 10.1016/j.sapharm.2019.08.031. - PubMed

Publication types

LinkOut - more resources