Changes in cost-related nonadherence among US adults with multiple chronic conditions from 2019 to 2023.

IF 2.9 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2025-07-01 DOI:10.18553/jmcp.2025.31.7.662

Alejandro Amill-Rosario, Julia F Slejko, Susan dosReis

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引用次数: 0

Abstract

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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从2019年到2023年，美国患有多种慢性疾病的成年人中与费用相关的不依从的变化

背景：在患有多种慢性疾病的人群中，与费用相关的不依从（CRN），即不按处方服药以节省资金，可能仍然过高，特别是在2019冠状病毒病大流行等经济压力时期。然而，大流行后3年的经济困难对患有多种慢性疾病的个体中CRN水平的影响在很大程度上仍然未知。目的：研究美国患有多种慢性疾病的成年人在2020年（大流行）和2021年至2023年（大流行后1、2和3年）相对于2019年（大流行前）CRN患病率的变化。方法：这是一项重复横断面研究，使用2019-2023年全国健康访谈调查的数据。我们的研究样本包括27,413名年龄在18至64岁之间的美国成年人，他们患有14种慢性疾病中的两种或两种以上，并服用处方药。CRN（因变量）是一个二元测量值，如果被调查者支持4个节约成本行为问题中的1个（不购买药品补药、延迟补药、分药或跳过剂量以省钱），则值为1，否则为0。分析包括按年调查加权的CRN患病率估计和线性概率模型，评估2020-2023年相对于2019年的总体患病率变化，以及多个慢性疾病亚组（2、3和≥4种疾病）。结果：2019年CRN总患病率为18.9%，2020年为16.7%，2021年为13.5%，2022年为14.5%，2023年为15.5%。与2019年相比，所有年份的CRN均有所下降，但2021年仅显著下降2.2% (P = 0.001)， 2022年仅显著下降1.4% （P = 0.049）。亚组分析显示了这些结果的差异，与2019年相比，2021年CRN显著减少，仅限于报告三种慢性病的人。结论：与大流行前相比，美国在大流行后1年和2年患有多种慢性疾病的成年人报告的CRN减少，但患有4种或更多疾病的成年人在大流行后仍然脆弱。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.