(B03) Cost-Related Nonadherence Among Adults with Multiple Chronic Conditions in the US from 2013 to 2021

Publication Number: 615

Background: Cost-related nonadherence (CRN), i.e., not taking medication as prescribed to avoid the cost, may remain disproportionately high among individuals with chronic conditions, particularly during periods of economic stress, such as the COVID-19 pandemic. Medication nonadherence, such as CRN, can lead to poor health outcomes (e.g., premature mortality) and faster disease progression.

Objectives: We examine trends in CRN among adults with chronic conditions in the US from 2013 to 2021.

Methods: This cross-sectional study uses the 2013-2021 National Health Interview Survey, which is a household survey representative of the US population. Our sample includes 121,521 adults >18 years-old who reported at least one of six chronic conditions (asthma, diabetes, hypertension, coronary heart disease, history of cancer, and stroke), and had a prescription drug 12 months before the interview. CRN was a dichotomous (yes/no) measure created by endorsing at least one of the following four questions: not purchasing medicine refills, splitting pills, delaying refills, or skipping doses to save money. We calculated the survey-weighted prevalence of CRN for each year stratified by those with 1 versus those with >2 chronic conditions, age (18-44, 45-54, 55-64, 65+ years), and sex (females, males). We used survey-weighted logistic regression to estimate the odds ratio (OR) and the 95% confidence intervals (CI) between CRN and chronic conditions by survey year.

Results: In our sample, 35.7% were 18-44 years old, and 56.4% were females. Overall, the CRN prevalence declined from 15.8% in 2013 to 11.9% in 2019 (pre-COVID-19) to 7.9% in 2021 among those with 1 condition vs. 19.2%, 15.8%, and 11.7% for the same years among those with >2 chronic conditions. By age, the CRN prevalence followed the overall pattern but decreased more among the younger age groups with >2 chronic conditions: 44% (18-44 group) and 22% (45-54 group) from 2019 to 2021. By sex, CRN declined for both chronic condition groups from 2013 to 2018. Among males with >2 conditions, from 2019 to 2021, CRN decreased by 14.4% compared to 33.8% among females for the same years. Overall and by year, those with >2 chronic conditions were approximately two times more likely to experience CRN than those with 1 chronic condition (adjusted OR: 1.68, 95% CI: 1.5-1.9 in 2013; 2.0, 95% CI: 1.8-2.9 in 2019, and 2.1, 95% CI: 1.8-2.4 in 2021).

Conclusions: CRN declined for adults with chronic conditions, particularly after the pandemic, but remained disproportionally higher for those with >2 chronic conditions. This is a group at greater risk for poor health outcomes.