The Health Effects of Restricting Prescription Medication Use Due to Cost

TitleThe Health Effects of Restricting Prescription Medication Use Due to Cost
Publication TypeJournal Article
Year of Publication2004
AuthorsHeisler, MM, Langa, KM, Eby, EL, A. Fendrick, M, Kabeto, MU, Piette, JD
JournalMedical Care
Call Numberpubs_2004_Heisler_04.pdf
KeywordsDemographics, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Methodology

Background: High out-of-pocket expenditures for prescription medications may 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 two prospective cohort studies of adults who reported regularly taking prescription medications, using two 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=7,991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2-3 years of follow-up of reporting in 1995/96 having taken less medicine than prescribed because of cost during the prior two 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 diseaserelated 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 to 21.2 of those who had not (AOR: 1.76, 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 non-fatal 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 pre-existing cardiovascular disease with higher rates of angina and non-fatal heart attacks or strokes. Such cost-related medication restriction may be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.


Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485

Endnote Keywords

Health Insurance/Health Care Costs/Prescription Fees/Female/Multivariate Analysis/Prospective Studies/United States/Health Status/Health Services

Endnote ID


Citation Key6920