OBJECTIVES: Pharmacist-led programs support policy-driven quality measures to enhance medication adherence outcomes for older adults with chronic conditions. Nonetheless, the impact of pharmacist interventions may vary due to social determinants of health (SDOH). The objective of this study was to identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with hypertension, high cholesterol, and/or diabetes in the United States (US).

METHODS: Using the World Health Organization Commission on Social Determinants of Health and Pharmacy Quality Alliance Medication Access Conceptual Frameworks, publicly available National Health and Nutrition Examination Survey datasets (2009-2018) were cross-sectionally analyzed among respondents aged 65 and older with study diseases. Adherence was based on self-reported medication use. Data analysis included descriptive statistics, Rao-Scott Chi-Square tests, and logistic regression. Highly correlated predictors were removed to address multicollinearity, and the rest were consolidated into a single variable. The study used a significance level of 0.05.

RESULTS: The total number of respondents meeting the inclusion criteria was 5,513. Univariate analysis showed that several structural (gender, p=.009; ethnicity, p=.038; social class, p=.023) and intermediary (e.g., level of alcohol consumption, p=.004; disability status, p=.014; affordability of household balanced meals, p<.001) determinants of health were significantly associated with medication adherence. Multivariate analysis revealed significant differences in medication adherence for alcohol consumption (p=.034) and usual place for healthcare (p=.001). For instance, individuals who usually went to a doctor’s office or health maintenance organization had 330% higher odds of adhering to medications than those with no usual place for healthcare (p<=.001).

CONCLUSIONS: Study findings underscore pertinent implications for policy and pharmacy practice, prioritizing SDOH most likely to affect medication adherence in common chronic conditions among older adults in the US. Strikingly, the observed relationship between alcohol consumption trends and adherence is a distinct finding warranting further investigation.