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. 2026 Feb;32(2):218-229.
doi: 10.18553/jmcp.2026.32.2.218.

Socioeconomic, demographic, and medication class determinants of medication adherence: A retrospective cohort study

Nikolay Lukyanchikov  1 , Joshua S Choi  1   2 , Phillip B Warner  1 , Claude J Nanjo  1   2 , Guilherme Del Fiol  1 , T Joseph Mattingly 2nd  3 , Kensaku Kawamoto  1   2
Affiliations

Socioeconomic, demographic, and medication class determinants of medication adherence: A retrospective cohort study

Nikolay Lukyanchikov et al. J Manag Care Spec Pharm. 2026 Feb.

Abstract

Background: Medication adherence varies across socioeconomic and demographic groups. Prior work has examined these relationships in selected populations and with zip code-level socioeconomic measures, but less is known about adherence patterns across all medications when using more granular community measures and location proxies.

Objective: To quantify associations between socioeconomic, demographic, and medication class factors and outpatient medication adherence.

Methods: We conducted a retrospective cohort study of 1,252,986 outpatient medication orders for 189,832 adults placed at a large health system in the Mountain West (University of Utah Health) from January 1, 2022, to January 1, 2024. Pharmacy, electronic health record, and Surescripts data were used. Medication adherence (proportion of days covered) was modeled with multivariate β regression with covariates including insurance, race, sex, marital and employment status, medication class, and Social Vulnerability Index socioeconomic quartile.

Results: Medicaid (adjusted odds ratio [aOR] = 0.87, P < 0.001) or no insurance (aOR = 0.80, P < 0.001) were associated with lower adherence than commercial coverage, whereas Medicare was associated with improved adherence (aOR = 1.06, P < 0.001, when compared with commercial insurance). Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native patients had lower adherence compared with White patients (aOR = 0.93, P < 0.001 and aOR = 0.96, P < 0.001, respectively). The most vulnerable Social Vulnerability Index quartile (Q4) modestly reduced adherence (aOR = 0.98, P < 0.001) compared with Q1. Antihypertensive, cholesterol-lowering, antidepressant, and heart failure drugs had markedly higher adherence (aORs 1.35-1.60, P < .01, when compared with other medication classes).

Conclusions: Several individual-level factors had strong associations with adherence. Community-level socioeconomic vulnerability had a modest association.

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Conflict of interest statement

This work was funded by the University of Utah ReImagine EHR initiative. The University of Utah ReImagine EHR team led by Dr Kawamoto is engaged in sponsored research with Surescripts on unrelated topics.

Figures

FIGURE 1
FIGURE 1
Study Data Flow
FIGURE 2
FIGURE 2
PDC Distribution by SVI Quartiles
FIGURE 3
FIGURE 3
PDC and SVI Map of the State of Utah
See this image and copyright information in PMC

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