Zhang James X, Crowe James M, Meltzer David O
a Department of Medicine , The University of Chicago , Chicago , IL , USA.
b School of Social Service Administration , The University of Chicago , Chicago , IL , USA.
J Med Econ. 2017 Jul;20(7):752-759. doi: 10.1080/13696998.2017.1326383. Epub 2017 May 19.
Cost-related non-adherence (CRN) to medical care is a persistent challenge in healthcare in the US. Gender is a key determinant of many healthcare behaviors and outcomes. Understanding variation in CRN by gender may provide opportunities to reduce disparities and improve outcomes.
This study aims to examine the differential rates in CRN by gender across a spectrum of socio-economic factors among the adult population in the US.
Data from the 2015 National Financial Capability Study (NFCS) were used for this study. CRN is identified if a respondent indicated not filling a prescription for medicine because of the cost and/or skipping a medical test, treatment, or follow-up recommended by a doctor because of the cost in the past 12 months. The differential rates in CRN by gender were assessed across socio-economic strata. A multivariable logistic regression analysis was performed to evaluate the difference in CRN rates by gender, controlling for potential confounders.
A total of 26,287 adults were included in the analyses. Overall, the weighted CRN rate in the adult population is 19.8% for men and 26.2% for women. There was a clear pattern of differential rates in CRN across socio-economic strata by gender. Overall, men were less likely to report CRN (AOR = 0.74; 95% CI = 0.69-0.79), controlling for other risk factors.
More research is needed to understand the behavioral aspects of gender difference in CRN. Patient-centered healthcare needs to take gender difference into account when addressing cost-related non-adherence behavior.
与费用相关的医疗不依从(CRN)是美国医疗保健领域长期存在的挑战。性别是许多医疗行为和结果的关键决定因素。了解CRN在性别上的差异可能为减少差异和改善结果提供机会。
本研究旨在考察美国成年人群体中,在一系列社会经济因素范围内,CRN在性别上的差异率。
本研究使用了2015年国家金融能力研究(NFCS)的数据。如果受访者表示在过去12个月里因费用问题未按处方买药和/或因费用问题跳过医生建议的医学检查、治疗或随访,则被认定为CRN。在社会经济阶层中评估CRN在性别上的差异率。进行多变量逻辑回归分析,以评估在控制潜在混杂因素的情况下,CRN率在性别上的差异。
共有26287名成年人纳入分析。总体而言,成年人群体中男性的加权CRN率为19.8%,女性为26.2%。CRN在性别上的差异率在社会经济阶层中呈现出明显的模式。总体而言,在控制其他风险因素的情况下,男性报告CRN的可能性较小(比值比=0.74;95%置信区间=0.69-0.79)。
需要更多研究来了解CRN中性别差异的行为方面。以患者为中心的医疗保健在解决与费用相关的不依从行为时需要考虑性别差异。