Socioeconomic factors associated with medication non-use among people with hypertension and diabetes in Jamaica. Public
Ricketts, Janique (Summer 2024)
Abstract
Background: Stroke, ischemic heart disease, and diabetes mellitus are among the top 5 causes of death for Jamaican adults. However, data on the social determinants of these conditions are sparse. For this study we examined possible social determinants of health associated with medication non-use among Jamaican adults with hypertension and/or diabetes.
Methods: Data were from the Jamaica Survey of Living Conditions 2018. This national household survey included data on social determinants of health (SDoH) including education, age, social security program enrollment, income sources, self-rated health status, and self-reported health conditions. All descriptive analyses were performed across the five (SDoH) domains: social, economic, environmental, educational, and health. Multivariable logistic regression was used to estimate the weighted unadjusted and adjusted odds ratios and 95% confidence intervals (95% CI) to evaluate the association between the SDoH and medication non-use among adults with diabetes, hypertension, or both conditions.
Results: The mean age of the total sample of 2135 respondents was 60.9±14.7 years. The prevalence of diabetes in the study population was 36.2% (782) while hypertension was 87.1% (1843).
Across the five SDoH domains, age-group 25-34 (aOR=4.41, 95% CI: 1.18–16.53), NHF enrollment (aOR=0.55, 95% CI: 0.36–0.84), employment as a farmer (aOR=0.42, 95% CI: 0.22–0.77), rented or leased home (aOR=0.53, 95% CI: 0.34-0.83), residing in a rural area (aOR=2.42, 95% CI: 1.38–4.25) or other urban areas (aOR=2.72, 95% CI: 1.49-4.50), presence of diabetes (aOR=0.24, 95% CI: 0.24-0.75), and health perception less than good (aOR=0.61, 95% CI: 0.40-0.93) were associated with medication non-use among those with hypertension.
Among those with diabetes, age-group 25-34 (aOR=80.67, 95% CI: 6.30–981.51) and 35-44 (aOR=14.90, 95% CI: 1.27–174.66), male sex (aOR=1.23, 95% CI: 0.84-1.82), JADEP enrollment (aOR=2.27, 95% CI = 1.08–4.79), residing in rural areas (aOR=3.03, 95% CI: 1.06–8.72) or other urban areas (aOR=3.59, 95% CI: 1.24–10.43), and disability status (aOR=3.2 95%CI: 1.43–7.12) were associated with medication non-use.
Conclusion: Significant association of medication non-use were seen across all SDoH domains except educational attainment for adult persons with diabetes and hypertension in Jamaica.
Table of Contents
Table of Contents
List of Figures.
List of Tables.
CHAPTER 1. 1
Introduction and Rationale. 1
Thesis Problem: 2
Thesis Purpose: 2
Approach: 2
CHAPTER 2. 4
Review of the Literature. 4
Impact of Type 2 Diabetes and Hypertension on Public Health. 4
Role of Social Determinants of Health on Cardiovascular outcomes. 5
CHAPTER 3. 9
Methodology. 9
The Survey Methods. 9
Data Analysis. 10
Model Development: 11
IRB Approval 12
CHAPTER 4. 13
Results. 13
Demographics: 13
Social Domain: 15
Economic Domain: 15
Environmental Domain: 16
Educational Domain: 18
Health Domain: 18
CHAPTER 5. 19
Discussion. 19
Demographics. 19
Social Domain: 20
Economic Domain: 20
Environmental Domain: 20
Educational Domain: 20
Health Domain: 20
Conclusions, Implications and Recommendations. 21
Limitations and strengths: 21
Figures. 23
Tables. 24
References. 34
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