PM2092: Perceived Discrimination and Medication Adherence in Adolescents and Young Adults with Chronic Kidney Disease

Background: We have previously shown that Black adolescents and young adults (AYAs) with chronic kidney disease (CKD) have lower medication adherence than White AYAs with CKD. Perceived discrimination (PD) is an important social determinant of health for individuals of racial, ethnic, gender, and other minority groups. PD is associated with lower medication adherence in adults with hypertension, psychiatric diagnoses, HIV, and tuberculosis. PD and medication adherence in youth is underexplored. We hypothesized that PD would be higher in Black compared to White AYAs with CKD, and that higher PD would be associated with lower antihypertensive medication adherence.

Methods: This is a cross-sectional secondary analysis of a 2-year longitudinal study of antihypertensive medication adherence in AYAs with CKD (stages 1-5). Participants were included if they completed the 6-item subscale of the Multicultural Events Schedule for Adolescents survey (scored 0-6, 0 = no PD), which measured PD, and concurrently-assessed antihypertensive medication adherence measured three ways: (1) medication event monitoring system (MEMS; electronic pill bottle cap), (2) medication possession ratio (MPR; pharmacy refill data), and (3) provider-reported estimate of AYAs’ adherence. For this analysis, only Black and White AYAs were included. Unadjusted and adjusted (including age, gender, insurance, and race as covariates) multivariable regression models were conducted to determine the association of PD with each measure of adherence (linear regression for MEMS and MPR, logistic regression for provider-reported adherence).

Results: Participants included 77 AYAs with CKD (mean age = 14.87 years) who were diverse in terms of sociodemographic characteristics (52% Black, 55% male, 42% public insurance, 31% <$50k household income (Table 1)). In the overall sample, PD scores were low (median=0, IQR=0-1). There were no significant differences in PD scores between Black (median=0, IQR=0-1.75) and White (median=0, IQR=0-1) AYAs (p=0.26). PD was not significantly associated with any adherence outcomes in both unadjusted and adjusted models (Table 2).

Conclusion: Contrary to our hypotheses, there were no significant differences in PD between Black and White AYAs with CKD, and PD was not associated with medication adherence. Limitations include that the MESA scale measures PD broadly in society and is not specific to the healthcare setting. Also, it may have been informative to include parental measures of PD, as parents often guide youth healthcare decision-making and behaviors. That said, perhaps the low PD levels in our sample reflect that adolescence may be a critical time of identity development when AYAs have not yet negatively internalized racial experiences. Providers can support positive AYA racial identity development and improved health outcomes by promoting critical consciousness to help AYAs think critically about oppressive realities and feel empowered to challenge societal inequities.