BACKGROUND:Previous studies have shown differences inadherencetoinhaledcorticosteroids(ICSs) byrace-ethnicity, yet little is known aboutfactorsthat contribute toadherencewithin these groups. Environmental stressors, such ascrimeexposure, which has beenassociatedwith asthma morbidity, might also predict ICSadherence.OBJECTIVE:We sought to identifyfactorsassociatedwith ICSadherenceamong patients with asthma and among African American patients and white patients separately.METHODS:Study patients with asthma were aged 18 to 50 years and were enrolled in a large southeast Michigan health maintenance organization between January 1, 1999, and December 31, 2001. The primary outcome, ICSadherence, was calculated by linking prescription-fill data with dosage information. Predictor variables included age, sex,race-ethnicity, measures of socioeconomic status (SES), average ICS copay, existing comorbidities, andcrimerate in area of residence.RESULTS:Adherenceinformation was available for 176 patients. ICSadherencewas lower among African American patients (n = 75) when compared with white patients (n = 94; 40% vs 58%, respectively; P = .002). Among white patients,adherencewas significantly lower for women when compared with men. Among African American patients, age and residentialcrimerates were positively and negativelyassociatedwith ICSadherence, respectively. Areacrimeremained a predictor ofadherencein African American patients, even after adjusting for multiple measures of SES.CONCLUSIONS:This study suggests that an environmental stressor, areacrime, provides additional predictive insight into ICS-adherent behavior beyond typical SESfactors.CLINICAL IMPLICATIONS:Better understanding of environmentalfactorsthat influence ICSadherencemight aid in efforts to improve it.
