Cost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases |
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| Institution: | 1. Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, CA;2. Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA;3. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine;4. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT;5. NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, CA;6. Baylor University Medical Center, Dallas, TX;7. Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN;1. Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University, Homburg, Germany;2. Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany;3. Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany;1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN;2. Enterprise Application Services, Mayo Clinic, Rochester, MN;3. Division of Hematology, Mayo Clinic, Rochester, MN;4. Research Systems Operations, Mayo Clinic, Rochester, MN;5. Research Systems Operations, Mayo Clinic, Scottsdale, AZ;1. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada;2. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada;3. Department of Medicine, University of Toronto, Ontario, Canada;4. Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Ontario, Canada;5. Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Ontario, Canada;6. Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada;7. Division of Endocrinology & Metabolism, St. Michael’s Hospital, Toronto, Ontario, Canada;8. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada;9. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada |
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| Abstract: | ObjectiveTo estimate the prevalence, risk factors, and consequences of cost-related medication nonadherence (CRN) in individuals with chronic liver diseases (CLDs) in the United States.Patients and MethodsUsing the National Health Interview Survey from January 1, 2014, to December 31, 2018, we identified individuals with CLDs. Using complex weighted survey analysis, we obtained national estimates and risk factors for CRN and its association with cost-reducing behaviors and measures of financial toxicity. We evaluated the association of CRN with unplanned health care use, adjusting for age, sex, race/ethnicity, insurance, income, education, and comorbid conditions.ResultsOf 3237 respondents (representing 4.6 million) US adults with CLDs, 813 (representing 1.2 million adults, or 25%; 95% CI, 23% to 27%) reported CRN, of whom 68% (n=554/813) reported maladaptive cost-reducing behaviors. Younger age, female sex, low income, and multimorbidity were associated with a higher prevalence of CRN. Compared with patients without CRN, patients experiencing CRN had 5.1 times higher odds of financial hardship from medical bills (adjusted odds ratio aOR], 5.05; 95% CI, 3.73 to 6.83) and 2.9 times higher odds of food insecurity (aOR, 2.85; 95% CI, 2.02 to 4.01). The CRN was also associated with 1.5 times higher odds of emergency department visits (aOR, 1.46; 95% CI, 1.11 to 1.94).ConclusionWe observed a high prevalence of CRN and associated consequences such as high financial distress, financial hardship from medical bills, food insecurity, engagement in maladaptive cost-reducing strategies, increased health care use, and work absenteeism among patients with CLD. These financial determinants of health have important implications in the context of value-based care. |
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