Pos0746 Medication Non-Adherence Among Patients Receiving Immunosuppression: The Importance of Additional Chronic Diseases

Background: Medication adherence rates across diseases that require immunosuppression, including autoimmune disease, are historically low. Non-adherence is associated with worse autoimmune disease outcomes; however, it is unknown whether adherence rates related to cost barriers differ between medically immunosuppressed patients and similar patients with chronic diseases who also require long-term medication. Objectives: The purpose of this study was to evaluate how patients receiving immunosuppression who report cost-related medication non-adherence (CRMNA) differ from patients with other chronic disease who report CRMNA. Methods: We performed a cross-sectional study from the most recent edition of the National Health Interview Study (NHIS). The NHIS is a nationally representative interview survey targeting the noninstitutionalized population within the United States. Survey respondents were categorized into three groups: medically immunosuppressed without other chronic health conditions, the presence of chronic health conditions and not medically immunosuppressed, and both medically immunosuppressed and containing other chronic health conditions. Patients with autoimmune disease on immunosuppressive medication were included in the "medically immunosuppressed" group. The primary outcome of interest was whether patients reported CRMNA. A multivariable logistic regression model was used to evaluate the association of immunosuppression use with CRMNA when controlling for other covariates, accounting for survey weighting and complex survey design. Results: In our weighted sample of 17,842,529 individuals with CRMNA, 60.13% were female, 55.57% were under 50-years-old and 76.27% self-reported as White. Bivariate analysis demonstrated significant associations between patient demographics, education, insurance status, general health status, life satisfaction, immunosuppression status and CRMNA (Table 1). In the multivariate model (Figure 1) accounting for all covariates, the group with medical immunosuppression and chronic disease was more likely to report CRMNA (OR 1.5, 95% CI [1.17, 1.91], p<0.01). The group with medical immunosuppression but no chronic disease, however, did not differ significantly from the reference group (OR 0.77, 95% CI [0.5, 1.18], p=0.23). Other covariates in the final multivariate model that impacted CRMNA included ratio of family income to the poverty level (OR 0.43, 95% CI [0.33, 0.58], p<0.001 for family incomes greater than 5-times the poverty level when compared to families at or below the poverty level), being uninsured (OR 3.83, 95% CI [2.81, 5.21], p<0.001 when compared to public insurance) and self-reported dissatisfaction in life (OR 2.0, 95% CI [1.57, 2.54], p<0.001 when compared to people who reported overall good life satisfaction), amongst others (see Figure 1). Conclusion: Medically immunosuppressed patients with chronic health conditions experience greater likelihood of CRMNA than patients with chronic health conditions who are not immunosuppressed. Adherence to immunosuppressive regimens is important to public health because non-adherence is associated with worse outcomes. Future studies aimed at reducing CRMNA in immunosuppressed patients may consider interventions that target the role of chronic health conditions in non-adherence.REFERENCES: NIL. Table 1. Bivariate analysis and patient demographics comparing cost- and no-cost-related medication non-adherence across patient subgroups (p-value reported as result of chi-square testing, 95% confidence intervals in brackets). Acknowledgements: NIL. Disclosure of Interests: Samuel Good Goldman Sachs, Bryant England Boehringer Ingelheim, Boehringer Ingelheim, Elizabeth Volkmann Boehringer Ingelheim, Boehringer Ingelheim, Roche, CSL Behring, GSK, Kadmon, Forbius, Boehringer Ingelheim, Horizon, Prometheus.