多病共存與老年高血壓患者服藥不遵從行為之相關性研究

The Association Between Multimorbidity and Medication Non-Adherence in Elderly With Hypertension in Western China

背景：隨著年齡增加，高血壓患病率增加。服藥不遵從行為是導致血壓控制不佳，從而引起心腦血管意外、死亡率增高等的重要原因之一。多病共存是老年人常見的症狀，已成為WHO倡導全球共同關注的重要議題。既往研究顯示，多病共存是服藥不遵從行為的影響因素，但二者間的關係尚存在爭議。目的：瞭解大陸西部地區老年高血壓患者服藥不遵從行為及多病共存現狀，並探討多病共存與服藥不遵從行為間的關係。方法　採橫斷式研究設計，通過多階段抽樣選取成都、重慶、烏魯木齊3個城市共9個社區衛生服務中心的1,316位老年高血壓患者為研究對象，以結構式問卷進行資料收集，以百分比、平均數、獨立樣本t檢驗、卡方檢驗、Kruskal-Wallis H秩和檢驗，及二元Logistic迴歸進行統計分析。結果　老年高血壓患者服藥不遵從行為盛行率為28.4%，多病共存患病率77.0%；合併症數量是不遵從行為的影響因素，與無其他慢性病的患者相比，合併3種慢性病者不遵從行為之風險增加1.742倍（95%CI [1.017, 2.984]），合併4種者風險增加2.601倍（95% CI [1.489, 4.544]），合併5種及以上者風險增加3.262倍（95% CI [1.839, 5.788]）。此外，存在健康危險因素（OR = 1.715, 95% CI [1.263, 2.330]）和居住地區不同，也是老年高血壓患者服藥不遵從行為的影響因素。結論　隨著合併症數量的增加，老年高血壓患者存在服藥不遵從行為之風險增加。建議加強對多病共存的老年高血壓患者服藥遵從行為的監測和關注，並積極探討促進該類人群服藥遵從行為的介入措施。

Background: The prevalence of hypertension increases with aging. Medication non-adherence is an important reason for the failure to control hypertension effectively, which increases the risks of cardiovascular and cerebrovascular incidents and of mortality. Multimorbidity is common among the elderly and has become a WHO-supported priority of research worldwide. While recent research suggests an association between multimorbidity and medication non-adherence, the results are not yet conclusive. Purpose: The present study describes the condition of medication non-adherence and multimorbidity among a population of elderly with hypertension in western China and explores the extent of the association between multimorbidity and medication non-adherence. Methods: A cross-sectional design with multi-stage sampling was used to recruit 1,316 elderly with hypertension from nine community health centers in the cities of Chengdu, Chongqing, and Urumqi. Data were collected using the study questionnaire and analyzed using the mean, percentage, independent samples t test, Chi-square test, Kruskal-Wallis H test, and binary logistic regression. Results: The prevalence of medication non-adherence was 28.7%, and the prevalence of multimorbidity was 77.0%. Binary logistic regression analysis found the number of comorbidities to be a predictor of antihypertensive drug non-adherence, with those elderly with three (OR = 1.742, 95% CI [1.017, 2.984], four (OR = 2.601, 95% CI [1.489, 4.544] and more than five (OR = 3.262, 95% CI [1.839, 5.788] chronic conditions at significantly higher risk of non-adherence than their peers with no comorbidities. Other associated factors included poor health behaviors (OR = 1.715, 95% CI [1.263, 2.330] and region of residence. Conclusion: A positive association was found between medication non-adherence and the number of comorbidities in elderly with hypertension. This suggests the need for closer monitoring of the antihypertensive-drug prescription adherence of elderly with multiple chronic conditions and for further research to explore the measures that are necessary to improve medication adherence in this population.