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Changes in cost-related nonadherence among US adults with multiple chronic conditions from 2019 to 2023
Alejandro Amill-Rosario1, Julia F Slejko1, Susan dosReis1
1School of Pharmacy, University of Maryland, Baltimore.
Insights
Cost-related nonadherence (CRN) decreased post-pandemic for adults with multiple chronic conditions. However, individuals with four or more conditions remain vulnerable to CRN, highlighting ongoing economic challenges.
Area of Science:
- Health Services Research
- Public Health
- Health Economics
Background:
- Cost-related nonadherence (CRN), defined as not taking medications as prescribed to save money, disproportionately affects individuals with multiple chronic conditions.
- Economic stress, exemplified by the COVID-19 pandemic, exacerbates CRN.
- The long-term impact of economic hardship on CRN in this population remains understudied.
Purpose of the Study:
- To analyze changes in CRN prevalence among US adults with multiple chronic conditions.
- To compare CRN rates in the pandemic year (2020) and post-pandemic years (2021-2023) against pre-pandemic levels (2019).
Main Methods:
- A repeated cross-sectional study utilizing the National Health Interview Survey (2019-2023).
- Sample included 27,413 US adults (18-64 years) with at least two of 14 chronic conditions on medication.
- CRN was measured by self-reported cost-saving medication behaviors; analyses used survey-weighted prevalence and linear probability models.
Main Results:
- Overall CRN prevalence decreased from 18.9% in 2019 to 15.5% in 2023.
- Significant reductions in CRN were observed in 2021 (13.5%) and 2022 (14.5%) compared to 2019.
- Subgroup analysis revealed significant CRN reduction in 2021 only for those with three chronic conditions.
Conclusions:
- CRN decreased in the first two years post-pandemic compared to pre-pandemic levels in the US.
- Adults with four or more chronic conditions continue to face vulnerability to CRN, indicating persistent economic challenges.
Background:
Cost-related nonadherence (CRN), that is, not taking medication as prescribed to save money, may remain disproportionately high among individuals with multiple chronic conditions, particularly during periods of economic stress, such as the COVID-19 pandemic. However, the impact of economic hardship 3 years after the pandemic on CRN levels among individuals with multiple chronic conditions is still largely unknown.
Objective:
To examine changes in CRN prevalence in 2020 (pandemic) and 2021 to 2023 (post-pandemic years 1, 2, and 3) relative to 2019 (pre-pandemic) among adults with multiple chronic conditions in the United States.
Methods:
This is a repeated cross-sectional study using data from the National Health Interview Survey, 2019-2023. Our study sample included 27,413 US adults aged 18 to 64 years with 2 or more of any of 14 chronic conditions and who were prescribed medication. CRN (dependent variable) is a binary measure with values "1" if respondents endorsed 1 of the 4 cost-saving behavior questions-not purchasing medicine refills, delaying refills, splitting pills, or skipping doses to save money-and "0" otherwise. Analyses include survey-weighted CRN prevalence estimates by year and linear probability models assessing prevalence changes in 2020-2023 relative to 2019, overall, and by multiple chronic conditions subgroups (2, 3, and ≥4 conditions).
Results:
The overall CRN prevalence in 2019 was 18.9%, 16.7% in 2020, 13.5% in 2021, 14.5% in 2022, and 15.5% in 2023. CRN decreased in all years relative to 2019 but only significantly by 2.2% (P = 0.001) in 2021 and by 1.4% (P = 0.049) in 2022. The subgroup analysis shows variation in these results, with a significant reduction in CRN in 2021, relative to 2019, limited to those who reported 3 chronic conditions.
Conclusions:
Fewer adults with multiple chronic conditions reported CRN 1 and 2 years after the pandemic relative to the pre-pandemic in the United States, but those with 4 or more conditions remain vulnerable after the pandemic.
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