The Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC.
CMAJ. 2012 Feb 21;184(3):297-302. doi: 10.1503/cmaj.111270. Epub 2012 Jan 16.
Many patients do not adhere to treatment because they cannot afford their prescription medications, putting them at increased risk of adverse health outcomes. We determined the prevalence of cost-related nonadherence and investigated its associated characteristics, including whether a person has drug insurance.
Using data from the 2007 Canada Community Health Survey, we analyzed the responses of 5732 people who answered questions about cost-related nonadherence to treatment. We determined the national prevalence of cost-related nonadherence and used logistic regression to evaluate the association between cost-related nonadherence and a series of demographic and socioeconomic variables, including province of residence, age, sex, household income, health status and having drug insurance.
Cost-related nonadherence was reported by 9.6% (95% confidence interval [CI] 8.5%-10.6%) of Canadians who had received a prescription in the past year. In our adjusted model, we found that people in poor health (odds ratio [OR] 2.64, 95% CI 1.77-3.94), those with lower income (OR 3.29, 95% CI 2.03-5.33), those without drug insurance (OR 4.52, 95% CI 3.29-6.20) and those who live in British Columbia (OR 2.56, 95% CI 1.49-4.42) were more likely to report cost-related nonadherence. Predicted rates of cost-related nonadherence ranged from 3.6% (95% CI 2.4-4.5) among people with insurance and high household incomes to 35.6% (95% CI 26.1%-44.9%) among people with no insurance and low household incomes.
About 1 in 10 Canadians who receive a prescription report cost-related nonadherence. The variability in insurance coverage for prescription medications appears to be a key reason behind this phenomenon.
许多患者因负担不起处方药物而无法坚持治疗，从而增加了不良健康后果的风险。我们确定了与费用相关的不依从的流行率，并调查了其相关特征，包括是否有药物保险。
我们使用 2007 年加拿大社区健康调查的数据，分析了 5732 名回答与治疗相关的费用相关不依从问题的人的回答。我们确定了与费用相关的不依从的全国流行率，并使用逻辑回归评估了与一系列人口统计学和社会经济变量（包括居住省份、年龄、性别、家庭收入、健康状况和药物保险）之间的关联。
在过去一年中接受过处方的加拿大人中，有 9.6%（95%置信区间 [CI] 8.5%-10.6%）报告存在与费用相关的不依从。在我们调整后的模型中，我们发现健康状况较差的人（比值比 [OR] 2.64，95%CI 1.77-3.94）、收入较低的人（OR 3.29，95%CI 2.03-5.33）、没有药物保险的人（OR 4.52，95%CI 3.29-6.20）和居住在不列颠哥伦比亚省的人（OR 2.56，95%CI 1.49-4.42）更有可能报告与费用相关的不依从。从有保险和高家庭收入的人群中，预计与费用相关的不依从率为 3.6%（95%CI 2.4-4.5），到没有保险和低家庭收入的人群中，预计这一比率为 35.6%（95%CI 26.1%-44.9%）。
大约每 10 名接受处方的加拿大人中就有 1 人报告存在与费用相关的不依从。处方药物保险覆盖范围的差异似乎是造成这种现象的一个关键原因。
