Abstract
Aims
To examine factors that affect cost-related medication non-adherence (CRN), defined
as taking medication less than as prescribed because of cost, among adults with diabetes
and to determine their relative contribution in explaining CRN.
Methods
Behavioral Risk Factor Surveillance System data for 2013–2014 were used to identify
individuals with diabetes and their CRN. We modeled CRN as a function of financial
factors, regimen complexity, and other contextual factors including diabetes care,
lifestyle, and health factors. Dominance analysis was performed to rank these factors
by relative importance.
Results
CRN among U.S. adults with diabetes was 16.5%. Respondents with annual income <$50,000
and without health insurance were more likely to report CRN, compared to those with
income ≥$50,000 and those with insurance, respectively. Insulin users had 1.24 times
higher risk of CRN compared to those not on insulin. Contextual factors that significantly
affected CRN included diabetes care factors, lifestyle factors, and comorbid depression,
arthritis, and COPD/asthma. Dominance analysis showed health insurance was the most
important factor for respondents <65 and depression was the most important factor
for respondents ≥65.
Conclusions
In addition to traditional risk factors of CRN, compliance with annual recommendations
for diabetes and healthy lifestyle were associated with lower CRN. Policies and social
supports that address these contextual factors may help improve CRN.
Keywords
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Article info
Publication history
Published online: June 23, 2018
Accepted:
June 19,
2018
Received in revised form:
May 25,
2018
Received:
April 2,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.