고혈압 환자의 뇌졸중 발병에 대한 소득 수준의 영향 및 약물 투약 순응도의 매개효과: 국민건강보험공단 표본코호트 연구

초록

Objectives: This study aimed to determine the associations between income level and stroke incidence in hypertensive patients. We also tried to mea- sure the mediating effect of poor antihypertensive medication adherence through causal mediation analysis. Methods: This study used the National Health Insurance Service National Sample Cohort Data from 2006 to 2015. The study population was newly diagnosed patients with hypertension aged 18 to 80. The associations between the independent-dependent variables, the mediator-dependent variables were confirmed with Cox proportional hazards regression models. In order to verify the mediating effect of poor hypertension medication adherence between income level and stroke occur- rence, a weighting approach of causal mediation analysis method was used. Since age was the moderate variable, 18-49 years old and 50-80 years old were stratified. Results: Under 50 years of age, all the other income groups had a significantly higher risk of poor medication adherence than the high- income group. For the patients aged 50 and older, the low-income group and the Medical Aid beneficiaries had a higher risk of poor medication adher- ence compared to the high-income group. In the patient under 50 years of age, the risk for the stroke incidence of the low-income group and the Medi- cal Aid beneficiaries were higher than those in the high-income group. In the patients aged 50 and older, all the other income groups had a significantly higher risk of incidence of stroke. Causal mediation analysis showed that the mediated effect of poor medication adherence in all groups was not signifi- cant. Conclusions: Low income significantly increased poor hypertension medication adherence and the incidence of stroke. The mediated effect of poor medication adherence was not significant.

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