The sex-specific detrimental effect of diabetes and gender-related factors on pre-admission medication adherence among patients hospitalized for ischemic heart disease: insights from EVA study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes, gender-related factors, and diabetes in women, gender-related factors, and diabetes in pre-admission medication adherence among hospitalized patients for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire.We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence. Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of patients was low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men . Interestingly, reporting women with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004) was similar to clinical and gender-related factors. In a multivariate adjusted model only received status was associated with poor medication adherence (OR 0.55, 95% CI 0.31-0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95% CI 0.13-0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95% CI 0.35-0.99) .Conclusion: Pre-admission medication is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors are associated with adherence in a sex-specific manner.