Department of Medicine, 5841 S Maryland Ave, MC 5000, The University of Chicago, Chicago, Illinois, USA
Department of Health Policy and Management, Yale University, New Haven, Connecticut, USA.
BMJ Open. 2022 May 6;12(5):e051480. doi: 10.1136/bmjopen-2021-051480.
The access barrier to medication has been a persistent and elusive challenge in the US healthcare system and around the globe. Cost-related medication non-adherence (CRN) is an important measure of medication non-adherence behaviours that aim to avoid costs. Longitudinal study of CRN behaviours for the ageing population is rare.
Longitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially.
General population of older Americans.
Three cohorts of Americans aged between 50 and 54 (baby boomers), 65-69 (the silent generation) and 80 or above (the greatest generation) in 2004 who were followed to 2014.
Observational with no intervention.
Longitudinal CRN rates for three generational cohorts from 2004 to 2014. Population-averaged effects of a broad set of variables including sociodemographics, income, insurance status, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and comorbid conditions on CRN were derived using generalised estimating equation by taking into account repeated measurements of CRN over time for the three cohorts, respectively.
The three cohorts of baby boomer, the silent generation and the greatest generation with 1925, 2839 and 2666 respondents represented 12.3 million, 8.2 million and 7.7 million people in 2004, respectively. Increasing age was associated with decreasing likelihood of reporting CRN in all three generational cohorts (p<0.05), controlling for demographics, income, insurance status, functional status and comorbid conditions. All three generational cohorts had a higher prevalence of diabetes, cancer, heart conditions, stroke, a higher percentage of respondents with Medicare-Medicaid dual eligibility and lower percentage with private insurance in 2014 compared with 2004 (p<0.05).
The paradox of decreasing CRN rates, independent of disease burden, income and insurance status, suggests populations' CRN behaviours change as Americans age, bearing implications to social policy.
在美国医疗保健系统及全球范围内，药物获取障碍一直是一个持续存在且难以解决的挑战。与费用相关的药物不依从（CRN）是衡量药物不依从行为的一个重要指标，其目的是避免费用。针对老年人群进行 CRN 行为的纵向研究很少见。
使用健康与退休研究（Health and Retirement Study）进行的纵向研究，每两年评估一次自我报告的 CRN。
美国老年人群的一般人群。
2004 年年龄在 50-54 岁（婴儿潮一代）、65-69 岁（沉默一代）和 80 岁及以上（最伟大一代）的三组美国人，随访至 2014 年。
观察，无干预。
从 2004 年到 2014 年，对三个世代队列的纵向 CRN 率进行评估。通过考虑到三个队列的 CRN 随时间的重复测量，使用广义估计方程，从社会人口统计学、收入、保险状况、日常生活活动（ADL）和工具性日常生活活动（IADL）的限制以及合并症等广泛变量中得出了人口平均效应。
婴儿潮一代、沉默一代和最伟大一代的三个队列分别有 1925、2839 和 2666 名受访者，分别代表了 2004 年 1230 万人、820 万人和 770 万人。在所有三个世代队列中，年龄的增加与报告 CRN 的可能性降低相关（p<0.05），控制了人口统计学、收入、保险状况、功能状态和合并症等因素。与 2004 年相比，所有三个世代队列在 2014 年都有更高的糖尿病、癌症、心脏疾病、中风患病率，更高比例的受访者同时拥有医疗保险和医疗补助（Medicare-Medicaid）双重资格，以及更低比例的私人保险（p<0.05）。
与疾病负担、收入和保险状况无关的 CRN 率下降的矛盾现象表明，随着美国人年龄的增长，他们的 CRN 行为发生了变化，这对社会政策具有重要意义。
