Original Article

The Effect of Hypertension, Diabetes, and Hyperlipidemia on Medication Intake and Adherence: Analysis from Korean Health Panel Survey 2014-2017


Background: Hypertension, diabetes, and hyperlipidemia are common chronic diseases in South Korea, and medication is a key factor in managing these diseases and preventing disease advancement to multimorbidity. This study aimed to evaluate the effect of chronic disease on medication intake and adherence among Koreans.

Methods: This study was conducted utilizing data collected from 5,529 individuals that participated in the Korea Health Panel Survey (KHPS) in 2014-2017. The dependent variables were medication intake and adherence, and independent variables included socioeconomic status and the type of chronic disease. The differences in the medication intake and medication adherence by sociodemographic variables and the type of chronic disease were analyzed by chi-square test. The effect of hypertension, diabetes, and hyperlipidemia on medication intake and adherence was analyzed via multiple logistic regression using SAS statistical software.

Results: The rate of medication intake and adherence were significantly different among patients with hypertension, diabetes, and hyperlipidemia, especially lower in patients with hyperlipidemia compared to those with hypertension and diabetes. In multiple logistic regression analysis, the probability of medication intake increased in female gender, older age, medical aid, medication adherence was higher in married, lower educational level and lower household income. Compared to hyperlipidemia, patients with hypertension and diabetes had more likely to take medication as prescribed.

Conclusion: The importance of considering the type of chronic disease in developing and implementing public health programs aiming for improved medication adherence. Targeting better medication intake and adherence for each chronic disease could be a valuable policy strategy to effectively manage chronic diseases as well as prevent their complications.

1. Bloom DE, Cafiero E, Jané-Llopis E, et al (2012). The global economic burden of noncommunicable diseases (No. 8712). Program on the Global Demography of Aging.
2. Hajat C, Stein E (2018). The global burden of multiple chronic conditions: A narra-tive review. Prev Med Rep, 12: 284-293.
3. Bloom DE, Chen S, Kuhn M, et al (2018). The economic burden of chronic diseas-es: estimates and projections for China, Japan, and South Korea. The Journal of the Economics of Ageing, 100163.
4. Cho NH (2014). Diabetes burden and pre-vention in Korea and the Western Pacific Region. Diabetes Res Clin Pract, 2:S282-7.
5. Kim KY, Lee EM, Cho JH (2020). Factors Affecting Healthcare Utilization among Patients with Single and Multiple Chronic Diseases. Iran J Public Health, 49(12): 2367-2375.
6. Fierro MP (2009). Trends Alert—Costs of Chronic Diseases: What Are States Fac-ing? The Council of State Governments.
7. Ornstein SM, Nietert PJ, Jenkins RG, et al (2013). The prevalence of chronic diseas-es and multimorbidity in primary care practice: a PPRNet report. J Am Board Fam Med, 26(5): 518-24.
8. Ministry of Health & Welfare, Korea Cen-ters for Disease Control & Prevention. National Health Statistics (2018). Available from: https://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1438
9. Korean Cause of Death Statistics. Korean Statistics (2020). Available from: http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&bSeq=&aSeq=385219&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=
10. Centers for Disease Control and Prevention (2020). People with Certain Medical Con-ditions. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
11. Chun SY, Kim DW, Lee SA, et al (2020). Does Diabetes Increase the Risk of Con-tracting COVID-19? A Population-Based Study in Korea. Diabetes Metab J, 44(6): 897-907.
12. King DE, Xiang J, Pilkerton CS (2018). Mul-timorbidity trends in United States adults, 1988–2014. J Am Board Fam Med, 31(4): 503-513.
13. Lim ES, Ko YK, Ban KO (2013). Prevalence and risk factors of metabolic syndrome in the Korean population–Korean Na-tional Health Insurance Corporation Sur-vey 2008. J Adv Nurs, 69(7):1549-61.
14. Haynes RB, McDonald HP, Garg AX (2002). Helping patients follow prescribed treat-ment: clinical applications. JAMA, 288(22): 2880-3.
15. Aday LA, Begley CE, Lairson DR, et al (2004). Evaluating the Healthcare System: Ef-fectiveness, Efficiency, and Equity. Chicago, IL: Health Administration Press.
16. Balkrishnan R, Rajagopalan R, Camacho FT, et al (2003). Predictors of medication ad-herence and associated health care costs in an older population with type 2 diabe-tes mellitus: a longitudinal cohort study. Clin Ther, 25(11): 2958-71.
17. Gassmann D, Cheetham M, Siebenhuener K, et al (2017). The multimorbidity inter-action severity index (MISI): A proof of concept study. Medicine (Baltimore), 96(8):e6144.
18. Vetrano DL, Calderón-Larrañaga A, Ma-rengoni A, et al (2018). An international perspective on chronic multimorbidity: approaching the elephant in the room. J Gerontol A Biol Sci Med Sci, 73(10): 1350-1356.
19. Krousel-Wood M, Thomas S, Muntner P, et al (2004). Medication adherence: a key factor in achieving blood pressure con-trol and good clinical outcomes in hyper-tensive patients. Curr Opin Cardiol, 19(4): 357-62.
20. Ho PM, Rumsfeld JS, Masoudi FA, et al (2006). Effect of medication nonadher-ence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med, 166(17): 1836-41.
21. Kim S, Bennett K, Wallace E, et al (2018). Measuring medication adherence in older community-dwelling patients with multi-morbidity. Eur J Clin Pharmacol, 74(3): 357-364.
22. Korea Health Panel Study (2021). Available from: https://www.khp.re.kr:444/
23. Rolnick SJ, Pawloski PA, Hedblom BD, et al (2013). Patient characteristics associated with medication adherence. Clin Med Res, 11(2): 54-65.
24. Dabaghian FH, Rassouli M, Sadighi J, et al (2016). Adherence to prescribed medica-tions of Iranian traditional medicine in a group of patients with chronic disease. J Res Pharm Pract, 5(1): 52-7.
25. Wang W, Lau Y, Loo A, et al (2014). Medi-cation adherence and its associated fac-tors among Chinese community-dwelling older adults with hypertension. Heart Lung, 43(4): 278-83.
26. Dabaghian H, Karbaksh M, Sedaghat M (2005). Drug compliance in patients with type 2 diabetes mellitus in Shariati and Imam Khomeini hospitals.Payesh, 4(2): 103-111.
27. Wu JR, Lennie TA, Chung ML, et al (2012). Medication adherence mediates the rela-tionship between marital status and cardi-ac event-free survival in patients with heart failure. Heart Lung, 41(2): 107-14.
28. Napolitano F, Napolitano P, Angelillo IF, et al (2016). Medication adherence among patients with chronic conditions in Italy. Eur J Public Health, 26(1): 48-52.
29. Peng Z, Zhu L (2021). The impacts of health insurance on financial strain for people with chronic diseases. BMC Public Health, 21(1), 1-10.
30. Ministry of Health & Welfare & Korean Na-tional Health Insurance Service (2017). Available from: https://www.korea.kr/news/pressReleaseView.do?newsId=156220774
31. Lee H, Park JB, Hwang IC, et al (2020). As-sociation of four lipid components with mortality, myocardial infarction, and stroke in statin-naïve young adults: a na-tionwide cohort study. Eur J Prev Cardiol, 27(8): 870-881.
32. Kissela BM, Khoury JC, Alwell K, et al (2012). Age at stroke: temporal trends in stroke incidence in a large, biracial popu-lation. Neurology, 79(17): 1781-7.
33. Alkerwi AA, Pagny S, Lair ML, et al (2013). Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxem-bourg: findings from ORISCAV-LUX study. PLoS One, 8(3): e57920.
34. Boo S, Yoon YJ, Oh H (2018). Evaluating the prevalence, awareness, and control of hypertension, diabetes, and dyslipidemia in Korea using the NHIS-NSC database: A cross-sectional analysis. Medicine (Balti-more), 97(51):e13713.
35. Zelko E, Klemenc-Ketis Z, Tusek-Bunc K (2016). Medication adherence in elderly with polypharmacy living at home: a sys-tematic review of existing studies. Mater Sociomed, 28(2): 129-32.
36. Tanaka T, Okamura T, Yamagata Z, et al (2007). Awareness and treatment of hy-pertension and hypercholesterolemia in Japanese workers: the High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study. Hypertens Res, 30(10), 921-8.
37. Bosworth HB, Ngouyombo B, Liska J, et al (2018). The importance of cholesterol medication adherence: the need for be-havioral change intervention programs. Patient Prefer Adherence, 12: 341–348.
38. Ellis JJ, Erickson SR, Stevenson JG, et al (2004). Suboptimal statin adherence and discontinuation in primary and secondary prevention populations. J Gen Intern Med, 19(6): 638-45.
39. Gibson TB, Fendrick AM, Gatwood J, et al (2012). Gaps in Treatment, Treatment Resumption and Cost-sharing. Am J Pharm Benefits, 4(6): e159-e165.
40. Han E, Suh DC, Lee SM, Jang S (2014). The impact of medication adherence on health outcomes for chronic metabolic diseases: a retrospective cohort study. Res Social Adm Pharm, 10(6): e87-e98.
41. Howard RL, Avery AJ, Slavenburg S, et al (2007). Which drugs cause preventable admissions to hospital? A systematic re-view. Br J Clin Pharmacol, 63(2): 136-47.
42. Chisholm-Burns MA, Spivey CA (2012). The ‘cost’ of medication nonadherence: consequences we cannot afford to accept. J Am Pharm Assoc, 52(6): 823–6.
43. Zhang D, Wang G, Fang J, Mercado C (2017). Hyperlipidemia and medical ex-penditures by cardiovascular disease sta-tus in US adults. Med Care, 55(1), 4-11.
44. Kretchy IA, Asiedu-Danso M, Kretchy JP (2021). Medication management and ad-herence during the COVID-19 pandemic: perspectives and experiences from low-and middle-income countries. Res Social Adm Pharm, 17(1), 2023-2026.
45. Tan WY, Young BE, Lye DC, et al (2020). Association of hyperlipidemia and statin use with severity of COVID-19. Scientific Reports, 10(1), 1-7.
IssueVol 52 No 2 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v52i2.11887
Chronic disease Medication adherence Hypertension Diabetes mellitus Hyperlipidemia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Park J, Kim Y. The Effect of Hypertension, Diabetes, and Hyperlipidemia on Medication Intake and Adherence: Analysis from Korean Health Panel Survey 2014-2017. Iran J Public Health. 2023;52(2):340-349.