Cost-related medication nonadherence in adults with hypertension in the USA: implications for healthcare quality.

Background: Hypertension is a significant risk factor for cardiovascular diseases, and it contributed to 685 875 deaths in 2022 in the United States. While antihypertensive medications are effective, cost-related medication non-adherence (CRN) can hinder treatment. This study examined CRN among adults with hypertension, comparing older (≥65 years) and younger (18-64 years) individuals.

Methods: This analytical cross-sectional study utilized data from the National Health Interview Survey Sample from 2019 to 2022. Inclusion criteria involved responding yes to the question 'Have you ever been told by a doctor or health professional that you have hypertension?' and 'Are you currently taking medications for hypertension?'. Participants who lacked responses to any relevant questions were excluded (n = 4441). Participants were stratified into two age groups: 18-64 years old and ≥65 years old. CRN was determined based on measures such as skipping doses, taking less medication, delaying prescription refills, and forgoing medication due to the cost for any medication. Covariates included age, race, ethnicity, sex, insurance status, financial hardship, comorbidities, and geographical region. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results: Of 48 559 hypertensive adults, there was a higher percentage of men in the 18-64 years age group compared with the group aged over 65 (51% vs 46%, P-value < .001). In addition, most women (54.0%) were over 65, compared with 48.6% in women between age 18 and 64 years (P-value < .001). Women aged 18-64 years more likely (adjusted odds ratio (aOR) 1.44; 95% CI 1.18, 1.75) to experience CRN than men. Notably, uninsured individuals in both the 18-64 (aOR 2.21; 95% CI 1.51, 3.25) and ≥ 65 (aOR 5.55; 95% CI 1.36, 22.75) age groups were at increased risk of facing CRN.

Conclusion: To mitigate CRN, health quality strategies like prescribing generics, connecting patients with assistance programs, and implementing policies to reduce out-of-pocket costs are essential.