Obesity Modifies the Association of Race/Ethnicity with Medication Adherence in the CARDIA Study

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Patient Compliance; Medication Adherence; Continental Population Groups; Ethnic Groups; Body Weight; Obesity


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


Objective: To assess associations between race/ethnicity and medication adherence, and the potential modifying effects of weight category (normal, overweight, obese) in a community-based sample.

Study design and setting: We studied 1355 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study who were taking prescription medications in 2000-1. Medication adherence, as rated on the four-item Morisky medication adherence scale (score of 4 = maximum adherence), was reported for all participants.

Results: The mean age ± SD of participants was 40 ± 3.6 years; 45% were African American and 36% were male. Overall, Whites had a higher proportion of maximum adherence than African Americans (59 vs 41%, respectively; p = 0.001). However, this difference was statistically significant only for participants within the normal weight category, of whom 54% of Whites were maximally adherent versus 35% of African Americans (p < 0.05). After adjustment for possible confounding covariates, race/ethnicity was associated with adherence only in those of normal weight: the odds ratio for maximum adherence in Whites versus African Americans of normal weight was 1.98 (95% CI 1.13, 3.47). Within race/ethnicity subgroups, weight category was associated with adherence in Whites but not in African Americans.

Conclusion: Weight category modifies the association of race/ethnicity with medication adherence. The high levels of non-adherence observed among African Americans and obese and overweight Whites bodes poorly for treatment of obesity-associated diseases such as cardiovascular disease or diabetes mellitus.


Salas M, Kiefe CI, Schreiner PJ, Kim Y, Juarez L, Person SD, Williams OD. Obesity Modifies the Association of Race/Ethnicity with Medication Adherence in the CARDIA Study. Patient. 2008; 1(1): 41-54.

Journal/Book/Conference Title

The Patient: Patient-Centered Outcomes Research