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Gender differences in medication adherence among adolescent and young adult kidney transplant recipients

Boucquemont, Julie, PhD1; Pai, Ahna LH, PhD2,3; Dharnidharka, Vikas R, MD4,5; Hebert, Diane, MD6; Furth, Susan L, MD, PhD7,8; Foster, Bethany J, MD, MSCE9,10

doi: 10.1097/TP.0000000000002359
Original Clinical Science—General: PDF Only

Background Among kidney transplant recipients, gender differences in medication adherence may contribute to the higher graft failure risks observed in girls and young women compared with boys and young men. Our aim was to determine whether adherence differs by gender, and whether gender differences vary by age in adolescent and young adult kidney transplant recipients.

Methods We examined data from the 3-month run-in period (no intervention) of the randomized TAKE-IT trial. Adherence was monitored using electronic pillboxes in 136 patients (11-24 y) followed in 8 transplant centers in Canada and USA. We used ordinal logistic regression with generalized estimating equations to estimate the association between gender and each of daily taking (proportion of prescribed doses taken) and timing (proportion of prescribed doses taken on time) adherence, considering effect modification by age (11-16 vs. 17-24 years).

Results No difference in taking adherence was observed by gender among participants 11-16 years (OR=0.92 (95%CI 0.55-1.54)), whereas among participants 17-24 years, women had significantly greater odds of higher taking adherence scores (OR=3.03 (95%CI 1.20-7.66)) than men. Results were similar for timing adherence, with no difference among participants 11-16 years (OR=1.03 (95%CI 0.65-1.63)) but a greater odds of higher timing adherence scores in women than in men among participants 17-24 years (OR=3.26 (95%CI 1.43-7.45)). There were no differences in adherence assessed by self-report or SD of tacrolimus trough levels.

Conclusions Gender differences in adherence vary by age. Whereas younger adolescents show no adherence differences by gender, young women show much better adherence than young men.

1Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;

2Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH and

3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati OH;

4Department of Pediatrics, Washington University School of Medicine, St. Louis, MO and

5St. Louis Children's Hospital, St. Louis, MO;

6Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada;

7Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA and

8Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA;

9Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada, and

10Department of Pediatrics, McGill University, Montreal, Quebec, Canada.

Correspondence to: Bethany J Foster, E-mail: bethany.foster@mcgill.ca. 1001 Decarie Blvd, Montreal, QC. H4A 3J1

TAKE-IT registration number: Clinicaltrials.gov registration: NCT01356277 (May 17, 2011)

Authorship

All authors participated in research design, in the writing of the paper and in data analysis.

Disclosure

The authors of this manuscript have no relevant conflicts of interest to disclose, except Dr. Foster, who is a co-investigator on 2 investigator-initiated studies funded by Astellas Canada.

Funding

The study was funded by the American National Institutes of Health, National Institutes of Diabetes, Digestive and Kidney diseases (NIDDK; R01DK092977). The funder had no role in study design, data collection, analysis, interpretation of data, writing the report, or and the decision to submit the report for publication. Dr. Boucquemont, who was a postdoctoral fellow at the Research Institute of the McGill University Health Centre when this study was done, was supported by an RI MUHC – Desjardins Studentship in Child Health Research. Dr. Foster, a member of the Research Institute of the McGill University Health Centre, was supported by a Fonds de recherche du Quebec Santé Chercheur-boursier clinicien award.

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