The Health Effects of Restricting Prescription Medication Use Because of Cost

Bibliographic Data

ID9102668
AuthorsMichele Heisler (0000-0002-6889-2063, VA Ann Arbor Healthcare System, corresponding author), Kenneth M Langa (0000-0002-2798-1836, VA Ann Arbor Healthcare System, corresponding author), Elizabeth L Eby (VA Ann Arbor Healthcare System, corresponding author), A MARK FENDRICK (0000-0002-7734-6742), Mohammed U Kabeto, John D Piette (0000-0002-7241-2798, VA Ann Arbor Healthcare System, corresponding author)
Year2004
Volume42
Issue7
Pages626-634
Publication date2004-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000129352.36733.cc
PMID15213486
OpenAlexW2110318254
LanguageEN
Citations received36
References cited38

BACKGROUND: High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known. METHODS: We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression. RESULTS: In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort. CONCLUSIONS: Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage

Body mass index · Cohort study · Confidence interval · Environmental health · Health care · Health insurance · Logistic regression · Medical Expenditure Panel Survey · Medical prescription · National Health and Nutrition Examination Survey · National Health Interview Survey · Odds ratio · Poisson regression · Population · Prescription drug · Prospective cohort study · Internal Medicine · Medication Adherence and Compliance · Medicine · Pharmaceutical Economics and Policy · Pharmaceutical Practices and Patient Outcomes