Comparing Continuous and Binary Group-based Trajectory Modeling Using Statin Medication Adherence Data

Bibliographic Data

ID9097287
AuthorsRyan P Hickson (0000-0002-3448-589X, University of North Carolina at Chapel Hill, corresponding author), Izabela E Annis (0000-0002-5011-3471, University of North Carolina at Chapel Hill, corresponding author), Ley A Killeya-Jones (University of North Carolina at Chapel Hill), Ley A Killeya‐Jones (0000-0003-1315-663X, University of North Carolina at Chapel Hill, corresponding author), Gang Fang (0009-0003-2947-4613, University of North Carolina at Chapel Hill, corresponding author)
Year2021
Volume59
Issue11
Pages997-1005
Publication date2021-11-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001625
PMID34644285
OpenAlexW3207234510
LanguageEN
Citations received2
References cited43

BACKGROUND: Of 58 medication adherence group-based trajectory modeling (GBTM) published studies, 74% used binary and 26% used continuous GBTM. Few studies provided a rationale for this choice. No medication adherence studies have compared continuous and binary GBTM. OBJECTIVE: The objective of this study was to assess whether continuous versus binary GBTM: (1) impacts adherence trajectory shapes; and (2) results in the differential classification of patients into adherence groups. METHODS: Patients were prevalent statin users with myocardial infarction hospitalization, 66+ years old, and continuously enrolled in fee-for-service Medicare. Statin medication adherence was measured 6 months prehospitalization using administrative claims. Final GBTM specifications beyond default settings were selected using a previously defined standardized procedure and applied separately to continuous and binary (proportion of days covered ≥0.80) medication adherence measures. Assignment to adherence groups was compared between continuous and binary models using percent agreement of patient classification and the κ coefficient. RESULTS: Among 113,296 prevalent statin users, 4 adherence groups were identified in both models. Three groups were consistent: persistently adherent, progressively nonadherent, and persistently nonadherent. The fourth continuous group was moderately adherent (progressively adherent in the binary model). When comparing patient assignment into adherence groups between continuous and binary trajectory models, only 78.4% of patients were categorized into comparable groups (κ=0.641; 95% confidence interval: 0.638-0.645). The agreement was highest in the persistently adherent group (∼94%). CONCLUSIONS: Continuous and binary trajectory models are conceptually different measures of medication adherence. The choice between these approaches should be guided by study objectives and the role of medication adherence within the study-exposure, outcome, or confounder

Binary number · Confidence interval · Medication adherence · Myocardial infarction · Statin · Trajectory · Heart Failure Treatment and Management · Internal Medicine · Mathematics · Medication Adherence and Compliance · Medicine · Pharmaceutical Practices and Patient Outcomes

Tools

Open DOIOpen Access