Cost-Related Nonadherence and Mortality in Patients With Chronic Disease: A Multiyear Investigation, National Health Interview Survey, 2000-2014

• Published in: Preventing chronic disease 2020-12, Vol.17, p.E151-E151, Article 200244
• Main Authors: Van Alsten, Sarah C, Harris, Jenine K
• Format: Article
• Language: English
• Subjects: Angina pectoris; Cardiovascular disease; Chronic Disease; Chronic illnesses; Costs; Costs and Cost Analysis; Diabetes; Diabetes Mellitus; Health care policy; Heart attacks; Humans; Hypertension; Hypertension - drug therapy; Interviews; Medical screening; Medication Adherence; Mortality; Original Research; Questionnaires; Surveys and Questionnaires; Variables
• ISSN: 1545-1151; 1545-1151
• DOI: 10.5888/pcd17.200244

Prescription costs are rising, and many patients with chronic illnesses have difficulty paying for prescriptions. Missing or delaying medication because of financial concerns is common; however, the effects of cost-related nonadherence (CRN) on patient outcomes have not been described. Our objective was to determine if CRN is associated with higher all-cause and disease-specific mortality among patients living with diabetes and cardiovascular disease in a representative sample of US adults. We ascertained CRN, vital status, and cause of death for 39,571 patients with diabetes, 61,968 patients with cardiovascular disease, and 124,899 patients with hypertension in the 2000 through 2014 releases of the National Health Interview Survey. We used adjusted Cox proportional hazards models to estimate associations between CRN and all-cause mortality and CRN and disease-specific mortality. On average, 15% of the sample reported CRN in the year before interview. After adjusting for confounders, CRN was associated with 15% to 22% higher all-cause mortality rates for all conditions (diabetes hazard ratio [HR] = 1.18; 95% CI, 1.1-1.3; cardiovascular disease [CVD] HR = 1.15; 95% CI, 1.1-1.2; hypertension HR = 1.22; 95% CI, 1.2-1.3). Relative to no CRN, CRN was associated with 8% to 18% higher disease-specific mortality rates (diabetes HR = 1.18; 95% CI, 1.0-1.4; CVD HR = 1.09; 95% CI, 1.0-1.2; hypertension HR = 1.08; 95% CI, 0.9-1.3). Relative to full adherence, CRN is associated with higher mortality rates for patients with diabetes, cardiovascular disease, and hypertension, although associations may have weakened since 2011. Policies that increase prescription affordability may decrease mortality for patients experiencing CRN.