{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:40:57Z","timestamp":1792201257848,"version":"4.4.0"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Indiana Clinical and Translational Sciences Institute","award":["UL1TR002529"],"award-info":[{"award-number":["UL1TR002529"]}]},{"DOI":"10.13039\/100006975","name":"National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award","doi-asserted-by":"publisher","award":["UL1TR002529"],"award-info":[{"award-number":["UL1TR002529"]}],"id":[{"id":"10.13039\/100006975","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: The older adult population is rapidly expanding in the United States (US), with a high prevalence of high blood pressure, high cholesterol, and diabetes. Medication nonadherence is prevalent in this population, with less evidence on the influence of social determinants of health (SDoH). Thus, the objective of this study was to identify and prioritize SDoH associated with medication adherence among US older adults with these comorbidities. Method: 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\u20132018) were cross-sectionally analyzed among respondents aged 65 and older who were diagnosed with study diseases. Data analyses included descriptive statistics, and logistic regression using an alpha level of 0.05. Result: Analyses included 5513 respondents\u2019 data. Bivariate analysis revealed significant differences in medication adherence based on several structural (e.g., ethnicity) and intermediary (e.g., disability status) determinants of health. Multivariable analysis revealed significant differences in medication adherence for alcohol consumption (p = 0.034) and usual healthcare place (p = 0.001). Conclusions: The study findings underscore pertinent implications for public health and policy, with specific SDoH being the most likely to affect medication adherence in common chronic conditions among older adults in the US.<\/jats:p>","DOI":"10.3390\/pharmacy13010020","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T09:02:42Z","timestamp":1738918962000},"page":"20","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Social Determinants of Health and Medication Adherence in Older Adults with Prevalent Chronic Conditions in the United States: An Analysis of the National Health and Nutrition Examination Survey (NHANES) 2009\u20132018"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2907-3524","authenticated-orcid":false,"given":"Omolola A.","family":"Adeoye-Olatunde","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa J.","family":"Hastings","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Blakely","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences, University of Wyoming School of Pharmacy, Laramie, WY 82071, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LaKeisha","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-2506","authenticated-orcid":false,"given":"Azeez B.","family":"Aina","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1597-3967","authenticated-orcid":false,"given":"Fatimah","family":"Sherbeny","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1021\/acschemneuro.3c00531","article-title":"Aging Hallmarks and Progression and Age-Related Diseases: A Landscape View of Research Advancement","volume":"15","author":"Tenchov","year":"2024","journal-title":"ACS Chem. Neurosci."},{"key":"ref_2","unstructured":"Majmundar, M.K., and Hayward, M.D. (2018). Future Directions for the Demography of Aging: Proceedings of a Workshop, National Academies Press (US)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s12875-023-02070-0","article-title":"The Effect of Polypharmacy on Healthcare Services Utilization in Older Adults with Comorbidities: A Retrospective Cohort Study","volume":"24","author":"Doumat","year":"2023","journal-title":"BMC Prim. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The Global Burden of Multiple Chronic Conditions: A Narrative Review","volume":"12","author":"Hajat","year":"2018","journal-title":"Prev. Med. Rep."},{"key":"ref_5","unstructured":"National Center for Health Statistics (2025, February 02). Health, United States, [2019]: Table 39, Available online: https:\/\/www.cdc.gov\/nchs\/hus\/data-finder.htm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1080\/00140139.2017.1301574","article-title":"Medication Adherence: Staying within the Boundaries of Safety","volume":"61","author":"Mickelson","year":"2018","journal-title":"Ergonomics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1177\/1060028018765159","article-title":"Cost of Prescription Drug-Related Morbidity and Mortality","volume":"52","author":"Watanabe","year":"2018","journal-title":"Ann. Pharmacother."},{"key":"ref_8","unstructured":"(2024, January 08). National Council on Aging Top 10 Chronic Conditions Affecting Older Adults. Available online: https:\/\/www.ncoa.org\/article\/the-top-10-most-common-chronic-conditions-in-older-adults."},{"key":"ref_9","unstructured":"CDC (2025, February 02). Table 6. Leading Causes of Death and Numbers of Deaths, by Sex, Race, and Hispanic Origin: United States, 1980 and 2018, Available online: https:\/\/www.cdc.gov\/nchs\/data\/hus\/2019\/006-508.pdf."},{"key":"ref_10","unstructured":"(2025, February 02). NIMHD: Health Disparity Populations, Available online: https:\/\/www.nimhd.nih.gov\/about\/overview\/."},{"key":"ref_11","unstructured":"Pharmacy Quality Alliance (2025, February 02). Access to Care: Development of a Medication Access Framework for Quality Measurement. Available online: https:\/\/www.pqaalliance.org\/assets\/Research\/PQA-Access-to-Care-Report.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1111\/jch.13089","article-title":"Disparities in Hypertension and Cardiovascular Disease in Blacks: The Critical Role of Medication Adherence","volume":"19","author":"Ferdinand","year":"2017","journal-title":"J. Clin. Hypertens. Greenwich"},{"key":"ref_13","unstructured":"U.S. Department of Health and Human Services (2024, January 16). Healthy People 2030: Social Determinants of Health, Available online: https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health."},{"key":"ref_14","unstructured":"Centers for Medicare and Medicaid Services (2025, February 02). Social Determinants of Health State Health Official Letter, Available online: https:\/\/www.medicaid.gov\/sites\/default\/files\/2021-01\/sho21001.pdf."},{"key":"ref_15","unstructured":"(2025, February 02). CMS: Medicare 2021 Part C & D Star Rating Technical Notes, Available online: https:\/\/www.cms.gov\/files\/document\/2021technotes20201001.pdf-0."},{"key":"ref_16","unstructured":"American Pharmacies (2025, February 02). How CMS Star Ratings Will Affect Your Revenue. Available online: https:\/\/www.aprx.org\/-advocacy\/star-ratings-overview."},{"key":"ref_17","first-page":"1407","article-title":"Positive Deviants for Medication Therapy Management: A Mixed-Methods Comparative Case Study of Community Pharmacy Practices","volume":"17","author":"Lake","year":"2020","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s11606-020-06447-0","article-title":"The Impact of Social Determinants of Health on Medication Adherence: A Systematic Review and Meta-Analysis","volume":"36","author":"Wilder","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e008150","DOI":"10.1161\/CIRCOUTCOMES.121.008150","article-title":"Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort","volume":"15","author":"Wilder","year":"2022","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_20","unstructured":"CDC, and NCHS (2025, February 02). National Health and Nutrition Examination Survey: Continuous NHANES, Available online: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/Default.aspx."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"STROBE Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_22","unstructured":"WHO (2025, February 02). A Conceptual Framework for Action on the Social Determinants of Health. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/44489."},{"key":"ref_23","first-page":"100371","article-title":"Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes","volume":"12","author":"Blakely","year":"2023","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1093\/ajh\/hpaa093","article-title":"Factors Associated With Physician Recommendation of Home Blood Pressure Monitoring and Blood Pressure in the US Population","volume":"33","author":"Tang","year":"2020","journal-title":"Am. J. Hypertens."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hosmer, D., Lemeshow, S., and Sturdivant, R. (2013). Applied Logistic Regression, Wiley. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s11606-008-0699-5","article-title":"The Demographic Assessment for Health Literacy (DAHL): A New Tool for Estimating Associations between Health Literacy and Outcomes in National Surveys","volume":"23","author":"Hanchate","year":"2008","journal-title":"J. Gen. Intern. Med."},{"key":"ref_27","unstructured":"US Census Bureau (2024, December 09). Poverty Glossary, Available online: https:\/\/www.census.gov\/topics\/income-poverty\/poverty\/about\/glossary.html."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.jand.2017.09.030","article-title":"Associations of Alcoholic Beverage Consumption with Dietary Intake, Waist Circumference, and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003\u20132012","volume":"118","author":"Butler","year":"2018","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/s11606-017-4199-3","article-title":"Cultural Issues in Medication Adherence: Disparities and Directions","volume":"33","author":"McQuaid","year":"2018","journal-title":"J. Gen. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.sapharm.2018.09.006","article-title":"Medication Adherence and Barriers among Low-Income, Uninsured Patients with Multiple Chronic Conditions","volume":"15","author":"Adams","year":"2019","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e2314211","DOI":"10.1001\/jamanetworkopen.2023.14211","article-title":"Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022","volume":"6","author":"Dusetzina","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/MLR.0000000000001458","article-title":"Cost-Related Medication Nonadherence and Its Risk Factors among Medicare Beneficiaries","volume":"59","author":"Nekui","year":"2021","journal-title":"Med. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"561","DOI":"10.3122\/jabfm.2021.03.200361","article-title":"Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications","volume":"34","author":"Rohatgi","year":"2021","journal-title":"J. Am. Board Fam. Med. JABFM"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.amjmed.2014.01.002","article-title":"Treat or Eat: Food Insecurity, Cost-Related Medication Underuse, and Unmet Needs","volume":"127","author":"Berkowitz","year":"2014","journal-title":"Am. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/jamainternmed.2018.5011","article-title":"Association Between Supplemental Nutrition Assistance Program Participation and Cost-Related Medication Nonadherence Among Older Adults with Diabetes","volume":"179","author":"Pooler","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/MLR.0000000000000565","article-title":"Social Determinants of Health, Cost-Related Non-Adherence, and Cost-Reducing Behaviors among Adults with Diabetes: Findings from the National Health Interview Survey","volume":"54","author":"Patel","year":"2016","journal-title":"Med. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/00019442-200503000-00005","article-title":"How Does Depression Influence Diabetes Medication Adherence in Older Patients?","volume":"13","author":"Kilbourne","year":"2005","journal-title":"Am. J. Geriatr. Psychiatry Off. J. Am. Assoc. Geriatr. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"795","DOI":"10.7326\/0003-4819-149-11-200812020-00004","article-title":"Alcohol Screening Scores and Medication Nonadherence","volume":"149","author":"Bryson","year":"2008","journal-title":"Ann. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1111\/j.1530-0277.2008.00732.x","article-title":"Adjusting Alcohol Quantity for Mean Consumption and Intoxication Threshold Improves Prediction of Nonadherence in HIV Patients and HIV-Negative Controls","volume":"32","author":"Braithwaite","year":"2008","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1097\/01.ALC.0000171937.87731.28","article-title":"A Temporal and Dose-Response Association between Alcohol Consumption and Medication Adherence among Veterans in Care","volume":"29","author":"Braithwaite","year":"2005","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e0224706","DOI":"10.1371\/journal.pone.0224706","article-title":"Conceptualising Alcohol Consumption in Relation to Long-Term Health Conditions: Exploring Risk in Interviewee Accounts of Drinking and Taking Medications","volume":"14","author":"Madden","year":"2019","journal-title":"PLoS ONE"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e0205956","DOI":"10.1371\/journal.pone.0205956","article-title":"\u2018I Take My Tablets with the Whiskey\u2019: A Qualitative Study of Alcohol and Medication Use in Mid to Later Life","volume":"13","author":"Haighton","year":"2018","journal-title":"PLoS ONE"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1080\/00952990.2018.1456545","article-title":"A Review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for Screening in the United States: Past Issues and Future Directions","volume":"44","author":"Babor","year":"2018","journal-title":"Am. J. Drug Alcohol Abuse"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2150132721994018","DOI":"10.1177\/2150132721994018","article-title":"Primary Care Shortage in Medically Underserved and Health Provider Shortage Areas: Lessons from Delaware, USA","volume":"12","author":"Malayala","year":"2021","journal-title":"J. Prim. Care Community Health"},{"key":"ref_45","first-page":"100484","article-title":"Abandonment of Prescriptions in Medically Underserved Areas: Primary Medication Non-Adherence in Community Pharmacies in the Delta Region of the United States","volume":"15","author":"Li","year":"2024","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_46","unstructured":"(2024, November 29). Centers for Disease Control and Prevention Pharmacy-Based Interventions to Improve Medication Adherence, Available online: https:\/\/www.cdc.gov\/cardiovascular-resources\/php\/medication-adherence\/index.html."},{"key":"ref_47","unstructured":"(2024, November 29). American Society of Health-System Pharmacists Pharmacy and Medically Underserved Areas Enhancement Act. Available online: https:\/\/www.ashp.org\/advocacy-and-issues\/patient-access-to-pharmacist-services\/pharmacy-and-medically-underserved-areas-enhancement-act?loginreturnUrl=SSOCheckOnly."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"357","DOI":"10.4140\/TCP.n.2021.357","article-title":"Pharmacist Provider-Status Legislation Returns","volume":"36","author":"Baldwin","year":"2021","journal-title":"Sr. Care Pharm."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/13\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:28:48Z","timestamp":1760027328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/13\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,7]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["pharmacy13010020"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy13010020","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,7]]}}}