Do Duy, Geldsetzer Pascal
Heidelberg Institute of Global Health, University of Heidelberg, Germany, Stanford School of Medicine, Stanford University, 1701 Page Mill Rd, Palo Alto, CA 94304, United States.
Stanford School of Medicine, Stanford University, Heidelberg Institute of Global Health, University of Heidelberg, Germany, 291 Campus Drive, Stanford, CA 94305, United States.
medRxiv. 2020 Sep 23:2020.09.22.20199505. doi: 10.1101/2020.09.22.20199505.
Mail-order prescriptions are popular in the U.S., but the recent mail delays due to operational changes at the United States Postal Services (USPS) may postpone the delivery of vital medications. Despite growing recognition of the health and economic effects of a postal crisis on mail-order pharmacy consumers, little is known about the extent of mail-order prescription use, and most importantly, the population groups and types of medications that will likely be most affected by these postal delays.
The prevalence of mail-order prescription use was assessed using a nationally representative repeated cross-sectional survey (the Medical Expenditure Panel Survey) carried out among adults aged 18 and older in each year from 1996 to 2018. We stratified use of mail-order prescription by socio-demographic and health characteristics. Additionally, we calculated which prescription medications were most prevalent among all mailed medications, and for which medications users were most likely to opt for mail-order prescription.
500,217 adults participated in the survey. Between 1996 and 2018, the prevalence of using at least one mail-order prescription in a year among U.S. adults was 9.8% (95% CI, 9.5%-10.0%). Each user purchased a mean of 19.4 (95% CI, 19.0-19.8) mail-order prescriptions annually. The prevalence of use increased from 6.9% (95% CI, 6.4%-7.5%) in 1996 to 10.3% (95% CI, 9.7%-10.9%) in 2018, and the mean annual number of mail-order prescriptions per user increased from 10.7 (95% CI, 9.8-11.7) to 20.5 (95% CI, 19.3-21.7) over the same period. Use of mail-order prescription in 2018 was common among adults aged 65 and older (23.9% [95% CI, 22.3%-25.4%]), non-Hispanic whites (13.6% [95% CI, 12.8%-14.5%]), married adults (12.7% [95% CI, 11.8%-13.6%]), college graduates (12.2% [95% CI, 11.3%-13.1%]), high-income adults (12.6%, [95% CI, 11.6%-13.6%]), disabled adults (19.3% [95% CI, 17.9%-20.7%]), adults with poor health status (15.6% [95% CI, 11.6%-19.6%]), adults with three or more chronic conditions (24.2% [95% CI, 22.2%-26.2%]), Medicare beneficiaries (22.8% [95% CI, 21.4%-24.3%]), and military-insured adults (13.9% [95% CI, 10.8%-17.1%]). Mail-order prescriptions were commonly filled for analgesics, levothyroxine, cardiovascular agents, antibiotics, and diabetes medications.
The use of mail-order prescription, including for critical medications such as insulin, is increasingly common among U.S. adults and displays substantial variation between population groups. A national slowdown of mail delivery could have important health consequences for a considerable proportion of the U.S. population, particularly during the current Coronavirus disease 2019 epidemic.
邮购处方在美国很普遍，但由于美国邮政服务（USPS）运营变化导致近期邮件延误，可能会推迟重要药物的交付。尽管人们越来越认识到邮政危机对邮购药房消费者的健康和经济影响，但对于邮购处方的使用程度，以及最重要的是，哪些人群和药物类型可能受到这些邮政延误的影响最大，了解甚少。
使用1996年至2018年每年对18岁及以上成年人进行的具有全国代表性的重复横断面调查（医疗支出小组调查）来评估邮购处方的使用情况。我们根据社会人口统计学和健康特征对邮购处方的使用进行分层。此外，我们计算了所有邮寄药物中哪些处方药最普遍，以及用户最有可能选择邮购处方的药物。
500,217名成年人参与了调查。1996年至2018年期间，美国成年人中每年至少使用一张邮购处方的比例为9.8%（95%置信区间，9.5%-10.0%）。每位用户每年平均购买19.4（95%置信区间，19.0-19.8）张邮购处方。使用率从1996年的6.9%（95%置信区间，6.4%-7.5%）上升到2018年的10.3%（95%置信区间，9.7%-10.9%），同期每位用户每年的邮购处方平均数量从10.7（95%置信区间，9.8-11.7）增加到20.5（95%置信区间，19.3-21.7）。2018年，65岁及以上成年人（23.9%[95%置信区间，22.3%-25.4%]）、非西班牙裔白人（13.6%[95%置信区间，12.8%-14.5%]）、已婚成年人（12.7%[95%置信区间，11.8%-13.6%]）、大学毕业生（12.2%[95%置信区间，11.3%-13.1%]）、高收入成年人（12.6%，[95%置信区间，11.6%-13.6%]）、残疾成年人（19.3%[95%置信区间，17.9%-20.7%]）、健康状况不佳的成年人（15.6%[95%置信区间，11.6%-19.6%]）、患有三种或更多慢性病的成年人（24.2%[95%置信区间，22.2%-26.2%]）、医疗保险受益人（22.8%[95%置信区间，21.4%-24.3%]）和有军事保险的成年人（13.9%[95%置信区间，10.8%-17.1%]）中，邮购处方的使用很普遍。邮购处方通常用于镇痛药、左甲状腺素、心血管药物、抗生素和糖尿病药物。
在美国成年人中，包括胰岛素等关键药物的邮购处方使用越来越普遍，并且在不同人群之间存在很大差异。全国范围内的邮件投递放缓可能会对相当一部分美国人口产生重要的健康影响，尤其是在当前的2019冠状病毒病疫情期间。
