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Abstract：
Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation\'s \'Study on global AGEing and adult health (SAGE)\', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.
摘要：
背景：非传染性疾病（NCDs）是全球死亡的主要原因，对低收入和中等收入国家和中低收入国家的影响尤为严重。非传染性疾病患者的服药依从性差在印度很普遍，错过给药或停止治疗，并代表着日益增长的医疗保健和财政负担。目的：本研究旨在确定影响印度非传染性疾病成人用药依从性的因素。方法：我们进行了一项横断面研究，对世界卫生组织第二波“全球衰老与成人健康研究（SAGE）”进行二次数据分析，一项调查收集了来自印度各地主要老年人的数据。进行了双变量分析和多变量逻辑回归模型，以特别询问缺乏开始和停止治疗的原因。这项研究的报告是由STROBE指南提供的。结果：2,840名患有一种或多种非传染性疾病的患者的平均服药依从性为51%，反映了治疗的非启动和缺乏持久性。在这些组成部分中，预测不坚持用药的最强因素是多发病率（比值比0.47，95％CI0.40-0.56）。烟草使用（OR=0.76，CI0.59-0.98）和从未上过学（OR=0.75，CI0.62-0.92）与农村生活（OR=0.70，CI0.48-1.02），在多变量分析中,焦虑感(OR=0.84,CI0.66-1.08)和抑郁感(OR=0.90,CI0.70-1.16)是与服药依从性无统计学显著关联的因素.年龄较大（OR=2.02，CI1.51-2.71）与改善的药物依从性显着相关，而财富增加与改善的药物使用之间的相关性较弱。局限性：SAGE2调查未显示患者是否按照处方说明服用药物剂量，因此我们的发现可能低估了药物不依从的真实发生率。结论：我们的分析提供了证据，表明印度的药物依从性差是多因素的，不同的社会经济和卫生系统因素相互作用，影响患者的决策。未来询问依从性的大规模调查应特别评估依从性的所有组成部分，虽然提高药物依从性的公共卫生干预措施应侧重于由于多发病率可能存在的障碍，抑郁和焦虑并存，低教育地位。
