Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China

Figures & data

Table 1 Adherence level based on sociodemographic characteristics

Demographic characteristics	Total (n=1,916)		Adherence (n=1,629)		Nonadherence (n=287)		χ^2	P-value
	n	%	n	%	n	%
Age (years)							12.564	0.014a
35–64	249	13.0	203	81.5	46	18.5
65–69	352	18.4	287	81.5	65	18.5
70–74	514	26.8	458	89.1	56	10.9
75–80	518	27.0	439	84.7	79	15.3
>80	283	14.8	242	85.5	41	14.5
Gender							2.829	0.093
Male	762	39.8	635	83.3	127	16.7
Female	1,154	60.2	994	86.1	160	13.9
Race							0.319	0.572
Han	1,874	97.8	1,592	85.0	282	15.0
Others	42	2.2	37	88.1	5	11.9
Residence							4.549	0.033a
Urban	583	30.4	511	87.7	72	12.3
Rural	1,333	69.6	1,118	83.9	215	16.1
Marital status							0.339	0.560
Married	1,520	79.3	1,296	85.3	224	14.7
Others	396	20.7	333	84.1	63	15.9
Educational level							12.004	0.007a
Illiterate	727	37.9	623	85.7	104	14.3
Primary school	632	33.0	539	85.3	93	14.7
Middle school	356	18.6	285	80.1	71	19.9
High school or above	201	10.5	182	90.5	19	9.5
Family members							0.018	0.893
1	245	12.8	209	85.3	36	14.7
>1	1,671	87.2	1,420	85.0	251	15.0
Underprivileged							0.281	0.596
No	1,840	96.0	1,566	85.1	274	14.9
Yes	76	4.0	63	82.9	13	17.1
Annual household income (yuan)							7.799	0.020a
<48,000	606	31.6	499	82.3	107	17.7
48,000–68,399	661	34.5	581	87.9	80	12.1
≥68,400	649	33.9	549	84.6	100	15.4
Employment							4.944	0.084
Unemployed	55	2.9	43	78.2	12	21.8
Employed	85	4.4	67	78.8	18	21.2
Retired	1,776	92.7	1,519	85.5	257	14.5
Outpatient medical reimbursement							11.395	0.001a
No	1,348	70.4	1,122	83.2	226	16.8
Yes	568	29.6	507	89.3	61	10.7

Note:

a P<0.05.

Table 2 Clinical characteristics of patients with hypertension

Clinical characteristics	Total (n=1,916)		Adherence (n=1,629)		Nonadherence (n=287)		χ^2	P-value
	n	%	n	%	n	%
Self-reported health status							4.705	0.095
(Very) Poor	352	18.4	310	88.1	42	11.9
Average	873	45.6	745	85.3	128	14.7
Well	691	36.1	574	83.1	117	16.9
Self-reported severity of hypertension							1.624	0.654
Asymptomatic	722	37.7	619	85.7	103	14.3
Mild discomfort	877	45.8	736	83.9	141	16.1
Moderate discomfort	264	13.8	228	86.4	36	13.6
Extreme discomfort	53	2.8	46	86.8	7	13.2
Complication							9.040	0.003a
No	697	36.4	570	81.8	127	18.2
Yes	1,219	63.6	1,059	86.9	160	13.1
Number of comorbidities							7.423	0.024a
0	331	17.3	269	81.3	62	18.7
1 or 2	1,089	56.8	923	84.8	166	15.2
≥3	496	25.9	437	88.1	59	11.9
Comorbidity
Patients with diabetes	599	31.3	533	89.0	66	11.0	10.734	0.001a
Patients with heart diseases	1,018	53.1	877	86.1	141	13.9	2.172	0.141
Patients with cerebrovascular diseases	650	33.9	562	86.5	88	13.5	1.603	0.205
Duration (years)							33.369	0.000a
1–4	294	15.3	221	75.2	73	24.8
5–9	455	23.7	378	83.1	77	16.9
≥10	1,167	60.9	1,030	88.3	137	11.7
Numbers of drugs							3.536	0.171
1	1,364	71.2	1,150	84.3	214	15.7
2	470	24.5	404	86.0	66	14.0
≥3	82	4.3	75	91.5	7	8.5
Drug classes
Calcium channel blocker	1,256	65.6	1,080	86.0	176	14.0	2.674	0.102
ACE inhibitor	242	12.6	203	83.9	39	16.1	0.281	0.596
ARB	314	16.4	276	87.9	38	12.1	2.441	0.118
β-Blocker	339	17.7	300	88.5	39	11.5	3.905	0.048a
Diuretic	85	4.4	73	85.9	12	14.1	0.052	0.820
Fixed-dose combinations	148	7.7	116	78.4	32	21.6	5.557	0.018a
Traditional medicines	83	4.3	63	75.9	20	24.1	5.663	0.017a
Regular clinical check							11.964	0.001a
No	1,395	72.8	1,162	83.3	233	16.7
Yes	521	27.2	467	89.6	54	10.4
Regular blood pressure check							11.939	0.001a
No	1,208	63.0	1,001	82.9	207	17.1
Yes	708	37.0	628	88.7	80	11.3
Blood pressure							13.693	0.000a
Uncontrolled	1,146	59.8	946	82.5	200	17.5
Controlled	770	40.2	683	88.7	87	11.3
Trust in different doctors							8.057	0.018a
Specialist	1,040	54.3	897	86.3	143	13.8
General practitioner	529	27.6	454	85.8	75	14.2
Uncertain	347	18.1	278	80.1	69	19.9
Health service utilizations in the past 1 year							0.002	0.965
No	1,464	76.4	1,245	85.0	219	15.0
Yes	452	23.6	384	85.0	68	15.0

Note:

a P<0.05.

Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker.

Table 3 Coefficient of factor loading and total variance explained in principal component analysis

Variables	F1	F2	F3	F4	F5	F6	F7	F8	F9
Complication	0.760	−0.122	−0.034	0.016	−0.116	−0.169	0.102	0.298	−0.041
Number of comorbidities	0.613	−0.186	−0.070	0.120	0.014	0.152	0.102	0.318	−0.178
Outpatient medical reimbursement	0.604	0.105	0.015	−0.030	−0.136	−0.422	0.154	0.212	−0.004
Duration	0.447	−0.080	0.012	−0.326	0.122	0.080	0.389	−0.100	0.112
Self-reported severity of hypertension	0.437	−0.247	−0.158	0.193	0.002	0.325	−0.235	0.013	−0.26
Marital status	0.149	0.785	−0.198	0.186	0.168	0.122	−0.042	−0.016	0.073
Family members	0.194	0.734	−0.223	0.179	0.185	0.241	0.013	−0.002	0.152
Annual household income	0.279	0.670	−0.014	−0.152	0.230	0.143	0.023	0.016	0.040
Blood pressure	0.063	0.098	0.796	0.165	0.144	0.026	−0.048	0.123	0.017
Regular clinical check	0.074	0.070	0.716	0.262	0.118	0.011	−0.019	−0.013	0.105
Regular blood pressure check	0.210	0.093	0.561	0.002	−0.011	0.036	−0.130	−0.036	−0.077
Residence	−0.117	−0.096	−0.251	0.566	0.214	−0.379	−0.031	0.269	0.121
Age	0.237	−0.263	0.015	−0.536	0.223	0.017	−0.448	0.085	0.203
Educational level	0.015	0.473	0.170	−0.180	−0.547	−0.117	−0.019	−0.045	−0.285
Employment	0.184	−0.019	0.016	−0.388	0.483	−0.295	−0.122	−0.112	0.144
Self-reported health status	−0.323	0.190	0.083	−0.041	0.080	−0.476	0.338	0.094	0.138
Gender	0.070	−0.448	0.078	0.215	0.315	0.307	0.507	−0.220	0.015
Numbers of drugs	0.339	0.038	0.003	−0.098	−0.345	−0.019	0.272	−0.427	0.262
Health service utilizations in the past 1 year	0.334	−0.066	−0.003	0.348	−0.166	−0.110	−0.270	−0.395	0.214
Trust in different doctors	−0.364	0.130	0.101	−0.277	−0.039	0.310	0.219	0.382	−0.069
Underprivileged	−0.050	−0.131	0.022	0.032	−0.376	0.286	−0.047	0.345	0.720
Initial eigenvalues	2.475	2.334	1.697	1.392	1.220	1.193	1.059	1.017	0.974
Cumulative %	11.786	22.903	30.985	37.615	43.423	49.102	54.143	58.986	63.625

Notes: Bold entries reflect the information of specific original variables that each of factors (F1–F9) included. Some original variables’ information also marked as bold entries, because they have a higher value in the corresponding factors, although these original variables were included in other factors at last based on highest value. F1 reflects complication, number of comorbidities, outpatient medical reimbursement, duration, self-reported severity of hypertension, named severity of disease factor; F2 reflects marital status, family members, annual household income, named family factor; F3 reflects blood pressure, regular clinical check, regular blood pressure check, named community management factor; F4 reflects residence and age, named individual factor; F5 reflects educational level and employment, named social factor; F6 reflects self-reported health status, named health status factor; F7 reflects gender, named gender factor; F8 reflects number of drugs, health service utilization in the past 1 year,and trust in different doctors, named treatment factor; F9 reflects underprivileged, named economic status factor.

Abbreviation: F, factor.

Table 4 Common factors associated with medication nonadherence using a binary logistic regression analysis

Associated factors	Crude OR (95% CI)	P-value	Adjusted ORb(95% CI)	P-value
Patients with diabetes	0.614 (0.458, 0.824)	0.001a	0.656 (0.479, 0.898)	0.008a
β-Blocker	0.697 (0.486, 0.999)	0.049a	0.979 (0.609, 1.573)	0.929
Fixed-dose combinations	1.637 (1.083, 2.474)	0.019a	1.638 (0.955, 2.808)	0.073
Traditional medicines	1.862 (1.108, 3.130)	0.019a	2.096 (1.097, 4.005)	0.025a
Severity of disease (F1)	0.702 (0.617, 0.799)	0.000a	0.654 (0.538, 0.795)	0.000a
Family (F2)	1.016 (0.896, 1.153)	0.802	1.013 (0.886, 1.157)	0.853
Community management (F3)	0.743 (0.649, 0.850)	0.000a	0.731 (0.635, 0.842)	0.000a
Individual factor (F4)	1.101 (0.972, 1.248)	0.131	1.090 (0.956, 1.242)	0.197
Social factor (F5)	0.896 (0.793, 1.013)	0.078	0.917 (0.798, 1.054)	0.223
Health status (F6)	0.989 (0.872, 1.122)	0.866	0.990 (0.868, 1.130)	0.883
Gender (F7)	0.897 (0.791, 1.017)	0.088	0.889 (0.776, 1.019)	0.090
Treatment (F8)	1.060 (0.935, 1.202)	0.360	1.074 (0.917, 1.258)	0.376
Economic factor (F9)	0.961 (0.845, 1.093)	0.545	0.930 (0.813, 1.065)	0.294

Notes:

a P<0.05.

b The regression model was adjusted for residence, patients with heart diseases, patients with cerebrovascular diseases, calcium channel blocker, ACE inhibitor, ARB, and diuretic.

Abbreviations: OR, odds ratio; ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; F, factor.