Social and Physical Environmental Factors Associated with Antihypertensive Medication Non-Adherence Among Older Adults with Hypertension in South Korea: Findings from the 2023 Community Health Survey.

Background: Hypertension requires lifelong antihypertensive medication to reduce cardiovascular risk. While most studies have focused on individual determinants of adherence, the role of perceived environmental and social characteristics remains unclear. This study examined the associations of depressive symptoms, satisfaction with the community environment, social participation, and social contact with antihypertensive medication non-adherence among older adults with hypertension in South Korea. Methods: A cross-sectional secondary analysis was conducted using the 2023 Korea Community Health Survey, including 44,822 adults aged 65 years and older with physician-diagnosed hypertension who were currently taking antihypertensive medication. Medication non-adherence was defined as taking medication on fewer than 24 of the previous 30 days, and associated factors were identified using complex sample multivariable logistic regression. Results: The prevalence of medication non-adherence was 0.4%. Higher satisfaction with the community environment was associated with lower odds of medication non-adherence (OR = 0.83, 95% CI = 0.72-0.95), whereas greater social participation was associated with higher odds (OR = 1.39, 95% CI = 1.09-1.78). Social contact, depressive symptoms, and the remaining characteristics were not significantly associated with medication non-adherence. Conclusions: Antihypertensive medication non-adherence among older adults is associated with perceived environmental characteristics as well as individual factors. Whether community-based approaches addressing these conditions can improve medication adherence requires evaluation in longitudinal or interventional studies.