Zhang James X, Meltzer David O
Section of Hospital Medicine, Department of Medicine, The University of Chicago, USA.
Section of Hospital Medicine, Department of Medicine, The University of Chicago, USA; Department of Economics, The University of Chicago, USA; Harris School of Public Policy, The University of Chicago, USA.
Integr Cancer Sci Ther. 2015 Dec;2(6):300-304. Epub 2015 Nov 6.
We aimed to assess the risk factors for cost-related medication non-adherence (CRN) among older patients with cancer in the United States. We used data from the 2010 Health and Retirement Study (HRS) to assess risk factors for CRN including age, insurance coverage, nursing home residence, functional limitations, and frequency of hospitalization among old patients with cancer. CRN was self-reported. We conducted a multivariate regression analysis to assess the effect of each risk factor. 293 (9.9%) of 2,953 older patients (50+ years) cancer patients reported CRN. Those who reported CRN were more likely to be younger, women, African American, and Hispanics. Compared to those with Medicare, those with no health insurance coverage were 97% more likely to report CRN. High number in limitation in activities of daily living and hospitalization significantly increased risk for CRN. Sicker cancer patients were more likely to report CRN. Lack of health insurance may have prevented the cancer patients from receiving optimal care. Together, these results suggest that expanding insurance coverage and improving insurance benefit design for cancer patients is likely to decrease CRN and improve outcomes.
我们旨在评估美国老年癌症患者中与费用相关的药物治疗不依从（CRN）的风险因素。我们使用了2010年健康与退休研究（HRS）的数据来评估CRN的风险因素，包括年龄、保险覆盖情况、养老院居住情况、功能受限以及老年癌症患者的住院频率。CRN通过自我报告获得。我们进行了多变量回归分析以评估每个风险因素的影响。2953名年龄在50岁及以上的癌症患者中有293名（9.9%）报告了CRN。报告CRN的患者更可能是年轻人、女性、非裔美国人以及西班牙裔。与拥有医疗保险的患者相比，没有医疗保险覆盖的患者报告CRN的可能性高97%。日常生活活动受限数量多以及住院显著增加了CRN的风险。病情较重的癌症患者更可能报告CRN。缺乏医疗保险可能使癌症患者无法获得最佳治疗。总之，这些结果表明，扩大癌症患者的保险覆盖范围并改善保险福利设计可能会降低CRN并改善治疗结果。
