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Abstract Number: 0131

Association of Numeracy with Medication Non-Adherence in Systemic Lupus Erythematosus

Mithu Maheswaranathan1, Amanda Eudy2, Ann Barr2, Catherine Howe3, Stacy Bailey4, Susan Hastings1, Jennifer Rogers2, Jayanth Doss2, Lisa Criscione-Schreiber1, Rebecca Sadun2, Megan Clowse5 and Kai Sun1, 1Duke University School of Medicine, Durham, NC, 2Duke University, Durham, NC, 3Duke University Hospital, Durham, NC, 4Northwestern University, Evanston, IL, 5Duke University, Chapel Hill, NC

Meeting: ACR Convergence 2021

Keywords: health behaviors, Health literacy, Health Services Research, medication adherence, Systemic lupus erythematosus (SLE)

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Session Information

Date: Saturday, November 6, 2021

Session Title: Health Services Research Poster I: Lupus, Inflammatory Arthritis, & More (0128–0148)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: Over 33% of U.S. adults have limited health literacy or numeracy. Limited health literacy and numeracy have been associated with higher disease activity and worse patient-reported outcomes in systemic lupus erythematosus (SLE). Health literacy involves ability to understand and use health information. A component of health literacy is numeracy, which involves quantitative math skills and is important for understanding and managing complex medication regimens. The objective of this study was to assess the relationship between health numeracy and medication adherence in SLE; we hypothesized that patients with limited numeracy would have higher rates of medication non-adherence.

Methods: SLE patients meeting ACR or SLICC criteria were recruited from a university clinic from March 2019 through January 2021. Numeracy was assessed with the Subjective Numeracy Scale (SNS-3); limited numeracy was defined as SNS-3 ≤ 12. Self-reported adherence for SLE medications was obtained using the visual analog scale component of the MASRI (Medication Adherence Self-Report Inventory), a patient-reported percentage of taking medications in the past 1 month (0-100%). In a subset of patients (n=146), objective medication adherence to SLE medications was also determined by Medication Possession Ratio (MPR), the proportion of days with medication supply over a 3-month period, using pharmacy refill data from the electronic health record. Non-adherence was defined as MASRI < 90% and MPR < 80%. We evaluated relationships between numeracy and adherence using descriptive statistics. Logistic regression models estimated the associations of numeracy with non-adherence, adjusting for education level.

Results: The cohort included 218 patients with SLE. The average age was 43, with 94% female and 59% Black race. Mean disease duration was 13 years, with average SLEDAI 3.0 and PGA 0.5; 45% had a history of lupus nephritis.

Compared to patients with adequate numeracy, those with limited numeracy had lower self-reported adherence (54% vs 73%) but paradoxically higher objective adherence (56% vs 44%). In a multivariable logistic regression adjusted for education, patients with low numeracy were twice as likely to self-report non-adherence by MASRI (OR 1.94; 95% CI: 1.07, 3.51) (Table 1).

Conclusion: In our cohort, limited numeracy and non-adherence are common. Although patients with low numeracy filled SLE medications at similar rates to those with adequate numeracy, we found paradoxically they were more likely to report non-adherence. This may reflect true non-adherence but could also be due to difficulty interpreting the adherence question or estimating the percentage they have taken medications. Future studies are needed to further elucidate this relationship.

Adjusted for education, patients with low numeracy were twice as likely to self-report non-adherence by MASRI (OR 1.94; 95% CI: 1.07, 3.51).


Disclosures: M. Maheswaranathan, None; A. Eudy, NIH NCATS Award Number 1KL2TR002554, 5, Pfizer, 5, Exagen, 5; A. Barr, None; C. Howe, None; S. Bailey, Luto, 2, Lundbeck, 2, 5, Merck, 5, Gordon and Betty Moore Foundation, 5, Retirement Research Foundation, 5, Sanofi, 2, National Institutes of Health, 5, Eli lilly, 5, Pfizer, 2, 5, University of Westminster, 2; S. Hastings, None; J. Rogers, Exagen, 2, 5, Pfizer, 5, Eli Lilly, 2, Immunovant, 2, Northwestern University, 2; J. Doss, Pfizer, 5; L. Criscione-Schreiber, None; R. Sadun, None; M. Clowse, UCB Pharma, 2, Pfizer, 5, GSK, 2, 5; K. Sun, None.

To cite this abstract in AMA style:

Maheswaranathan M, Eudy A, Barr A, Howe C, Bailey S, Hastings S, Rogers J, Doss J, Criscione-Schreiber L, Sadun R, Clowse M, Sun K. Association of Numeracy with Medication Non-Adherence in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/association-of-numeracy-with-medication-non-adherence-in-systemic-lupus-erythematosus/. Accessed January 30, 2023.
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