Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes: Findings From the National Health Interview Survey

• Published in: Medical care 2016-08, Vol.54 (8), p.796-803
• Main Authors: Patel, Minal R., Piette, John D., Resnicow, Kenneth, Kowalski-Dobson, Theresa, Heisler, Michele
• Format: Article
• Language: English
• Subjects: Cost Control - methods; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - therapy; Disease management; Female; Health behavior; Health care expenditures; Health Surveys; Humans; Insurance Coverage; Insurance, Health; Male; Middle Aged; Original Article; Patient Compliance; Polls & surveys; Savings; Self Care - economics; Social Determinants of Health
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000565

BACKGROUND:Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non–health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN. METHODS:Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN. RESULTS:Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05–1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5–1.67), and food insecurity (PR=1.30; 95% CI, 1.2–1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2–0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. CONCLUSIONS:Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.