{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T23:02:16Z","timestamp":1774998136155,"version":"3.50.1"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,12,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">More women than men experience recurrent strokes. Medication adherence is critical to prevent recurrence; however, studies investigating sex differences are limited. We examined sex differences in poststroke medication adherence, overall and by drug class, and identified influencing factors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients with first\u2010ever ischemic stroke were identified from a population\u2010based study (2008\u20132019). At 90\u2009days after a stroke, self\u2010reported medication adherence was defined as never or rarely missing a dose in a typical week for each secondary stroke prevention medication (antihypertensives, cholesterol\u2010lowering drugs, antiplatelets, anticoagulants). We generated prevalence ratios (PRs) using modified Poisson models to assess sex differences with and without adjustment for potential confounding factors, including demographics, social factors, health system\u2013related, lifestyle\u2010related, health condition\u2013related, prestrokehealth\u2013related, and stroke\u2010related factors. Among 1324 participants (48.4% women, 58.0% Mexican American individuals), women were more likely to report nonadherence to cholesterol\u2010lowering drugs (PR, 1.80 [95% CI, 1.14\u20132.84]) and antiplatelets (PR, 1.53 [95% CI, 1.003\u20132.34]). Adjusting for obesity attenuated while adjusting for age, marital status, access to care, smoking, and alcohol consumption accentuated sex differences. Race and ethnicity modified the sex difference in nonadherence to cholesterol\u2010lowering drugs (\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              =0.054) such that the sex difference was larger in Mexican American individuals (PR, 3.00 [95% CI, 1.65\u20135.48]) than in non\u2010Hispanic White individuals (PR, 1.30 [95% CI, 0.52\u20133.27). No significant sex differences were found for nonadherence to antihypertensives and overall nonadherence.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Poststroke medication nonadherence was more prevalent among women than men. This was partially due to the confounding effects of lifestyle, marital status, and access to care, suggesting potential subgroups for interventions to improve adherence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.036409","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T10:41:52Z","timestamp":1733308912000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Sex Differences in Nonadherence to Secondary Stroke Prevention Medications Among Patients With First\u2010Ever Ischemic Stroke"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5091-1222","authenticated-orcid":false,"given":"Chen","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-6343","authenticated-orcid":false,"given":"Mathew J.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Michigan State University East Lansing MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5636-3009","authenticated-orcid":false,"given":"Karen B.","family":"Farris","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5787-592X","authenticated-orcid":false,"given":"Lewis B.","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA"},{"name":"Stroke Program University of Michigan Medical School Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5539-5933","authenticated-orcid":false,"given":"Lynda D.","family":"Lisabeth","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA"},{"name":"Stroke Program University of Michigan Medical School Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001209"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.120.033133"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4981"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.117.018140"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31822f0423"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09660-y"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-012-1293-7"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.14001"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1159\/000488450"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1159\/000493530"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.110.579375"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2268"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.566950"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S147605"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1159\/000371574"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1179\/1743132812y.0000000107"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987316646026"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-016-0365-2"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1159\/000456618"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.084"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.1.40"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2019.104514"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-036418"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002658"},{"key":"e_1_3_2_27_2","first-page":"520","article-title":"Designing multi\u2010ethnic stroke studies: the brain attack surveillance in Corpus Christi (BASIC) project","volume":"14","author":"Smith MA","year":"2004","unstructured":"Smith MA, Risser JMH, Moy\u00e9 LA, Garcia N, Akiwumi O, Uchino K, Morgenstern LB. Designing multi\u2010ethnic stroke studies: the brain attack surveillance in Corpus Christi (BASIC) project. Ethn Dis. 2004;14:520\u2013526.","journal-title":"Ethn Dis"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003912"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.11.002"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7176.2008.07572.x"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.17.1853"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.024249"},{"key":"e_1_3_2_34_2","volume-title":"Adherence to Long\u2010Term Therapies: Evidence for Action","author":"World Health Organization","year":"2003","unstructured":"World Health Organization . Adherence to Long\u2010Term Therapies: Evidence for Action. World Health Organization; 2003."},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780100410"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2007.03.013"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e318230e861"},{"key":"e_1_3_2_38_2","volume-title":"Modern epidemiology","author":"Lash T","year":"2020","unstructured":"Lash T, VanderWeele T, Haneuse S, Rothman K. Modern epidemiology. Vol 4. Wolters Kluwer Health\/Lippincott Williams & Wilkins Philadelphia; 2020."},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.02.011"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10823-019-09381-9"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0019253"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/47.6.721"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac015"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.118.005562"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.15420\/ecr.2021.24"},{"key":"e_1_3_2_46_2","unstructured":"Allsop K Axelsen K Tarbell C. Use of Preventive Care Services Associated with Patient\u2010Provider Sex Concordance in the US. 2022."},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S340573"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200825010-00008"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.036409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T12:52:12Z","timestamp":1734439932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.036409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,17]]},"references-count":47,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2024,12,17]]}},"alternative-id":["10.1161\/JAHA.124.036409"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.036409","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,17]]},"assertion":[{"value":"2024-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e036409"}}