Gonzales Felisa, Zheng Zhiyuan, Yabroff K Robin
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Office of the Assistant Secretary for Planning and Evaluation, Washington, DC; Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
J Natl Cancer Inst. 2018 Feb 1;110(2):216-9. doi: 10.1093/jnci/djx164.
Little is known about the competing effects of increasing prescription drug costs and expansions in insurance coverage on prescription drug access and whether trends vary for adults with and without a cancer history. Using the 2010-2015 National Health Interview Survey, we examined trends in limited prescription drug access, operationalized as forgoing needed prescription drugs because of cost. The percentages of adults age 18 to 64 years with limited prescription drug access decreased over time: predicted margins from multivariable logistic regression models were 13.8% in 2010 vs 8.6% in 2015 for cancer survivors and 11.0% vs 6.8% for adults without a cancer history (adjusted odds ratio [aOR] for trend = 0.89, 95% confidence interval [CI] = 0.88 to 0.90). Access changed little for adults age 65 years and older. Among adults age 18 to 64 years, cancer survivors were more likely than those without a cancer history to report limited access to any prescription drug in all years (aOR from multivariable logistic regression model = 1.45, 95% CI = 1.31 to 1.61). However, trends did not differ by cancer history. Our findings suggest that expansions in health insurance coverage mitigated the effects of growing prescription drug costs to some extent for many individuals with and without a history of cancer.
关于处方药成本上升和保险覆盖范围扩大对处方药可及性的竞争影响，以及有和没有癌症病史的成年人的趋势是否不同，目前所知甚少。利用2010 - 2015年全国健康访谈调查，我们研究了有限处方药可及性的趋势，将其定义为因费用而放弃所需处方药。18至64岁有限处方药可及性的成年人比例随时间下降：多变量逻辑回归模型预测的边际比例在2010年为13.8%，在2015年癌症幸存者为8.6%，无癌症病史的成年人分别为11.0%和6.8%（趋势的调整优势比[aOR]=0.89，95%置信区间[CI]=0.88至0.90）。65岁及以上成年人的可及性变化不大。在18至64岁的成年人中，癌症幸存者在所有年份中比没有癌症病史的人更有可能报告难以获得任何处方药（多变量逻辑回归模型的aOR = 1.45，95% CI = 1.31至1.61）。然而，趋势在有无癌症病史之间没有差异。我们的研究结果表明，医疗保险覆盖范围的扩大在一定程度上减轻了许多有和没有癌症病史的人处方药成本上升的影响。
