Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
Center for Outcomes Research, Houston Methodist, Houston, TX.
Diabetes Care. 2022 Mar 1;45(3):594-603. doi: 10.2337/dc21-1757.
Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S.
We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013-2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN.
Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age <65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92).
In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.
美国因糖尿病而导致的医疗支出不断增加。药物依从性差与糖尿病患者的健康状况恶化有关。我们旨在研究美国糖尿病患者报告的与费用相关的药物不依从（CRN）的程度。
我们研究了来自全国健康访谈调查（NHIS）（2013-2018 年）的年龄≥18 岁、自我报告患有糖尿病的成年人，这是一项具有美国代表性的调查。报告过去一年因经济原因漏服、减少用药或延迟配药的成年人被认为经历了 CRN。总体和按年龄亚组（<65 岁和≥65 岁）估计 CRN 的加权患病率。使用逻辑回归来确定与 CRN 独立相关的社会人口统计学特征。
在 20326 名患有 NHIS 的糖尿病患者中，<65 岁的患者中有 17.6%（加权 230 万人）报告了 CRN，而≥65 岁的患者中有 6.9%（加权 70 万人）。医疗费用负担过重、缺乏保险、低收入、高合并症负担和女性是与各年龄段 CRN 独立相关的特征。缺乏保险、糖尿病病程、当前吸烟、高血压和高胆固醇血症与非老年人群中报告 CRN 的几率较高相关，但与老年人群无关。在老年人群中，胰岛素的使用显著增加了报告 CRN 的几率（比值比 1.51；95%CI 1.18，1.92）。
在美国，六分之一的非老年和十四分之一的老年糖尿病患者报告了 CRN。消除获取药物的经济障碍可能会提高这些患者的药物依从性，从而有可能改善他们的结局。
