Heisler Michele, Langa Kenneth M, Eby Elizabeth L, Fendrick A Mark, Kabeto Mohammed U, Piette John D
Veterans Affairs Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Med Care. 2004 Jul;42(7):626-34. doi: 10.1097/01.mlr.0000129352.36733.cc.
High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known.
We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression.
In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort.
Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.
处方药的高额自付费用可能导致慢性病患者减少用药。尚不清楚成年人因费用限制用药后是否会出现不良健康后果。
我们分析了两项前瞻性队列研究的数据，这两项研究针对的是报告经常服用处方药的成年人，数据来自健康与退休研究（HRS）的两波调查，该研究是1992年对51至61岁成年人进行的全国性调查，以及“最年长者资产与健康动态”（AHEAD）研究，该研究是1993年对70岁及以上成年人进行的全国性调查（n = 7991）。我们使用多变量逻辑回归和泊松回归模型，评估在1995 - 1996年报告因前两年费用问题而用药少于处方量的情况，对2至3年随访期间健康结局的独立影响。在调整了社会人口学特征、健康状况、吸烟、饮酒、体重指数（BMI）和共病慢性病的差异后，我们确定了基线时健康状况良好至极佳的受访者总体健康显著下降的风险，以及患有心血管疾病、糖尿病、关节炎和抑郁症的受访者出现新的疾病相关不良结局的风险。
在调整分析中，因费用限制用药的受访者中有32.1%报告健康状况显著下降，而未限制用药的受访者中这一比例为21.2%（调整后的优势比[AOR]为1.76；置信区间[CI]为1.27 - 2.44）。限制用药的心血管疾病受访者心绞痛发生率更高（11.9%对8.2%；AOR为1.5）。
