TY - JOUR T1 - Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. JF - Med Care Y1 - 2010 A1 - Michele M Heisler A1 - Choi, Hwajung A1 - Allison B Rosen A1 - Sandeep Vijan A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - John D Piette KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Female KW - Financing, Personal KW - Health Care Costs KW - Health Services Accessibility KW - Health Status Disparities KW - Hospitalization KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Medication Adherence KW - Middle Aged KW - Multivariate Analysis KW - Risk Factors KW - United States AB -

CONTEXT: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths.

OBJECTIVE: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost.

DESIGN AND SETTING: A retrospective biannual cohort study across 4 cross-sectional waves of the Health and Retirement Study, a nationally representative survey of adults older than age 50. Using multivariate logistic regression to adjust for baseline differences in sociodemographic and health characteristics, we assessed subsequent hospitalizations and deaths between 1998 and 2006 for respondents who reported that they had or had not taken less medicine than prescribed because of cost.

RESULTS: Respondents with cardiovascular disease who reported underusing medications due to cost were significantly more likely to be hospitalized in the next 2 years, even after adjusting for other patient characteristics (adjusted predicted probability of 47% compared with 38%, P < 0.001). The more survey waves respondents reported cost-related medication underuse during 1998 to 2004, the higher the probability of being hospitalized in 2006 (adjusted predicted probability of 54% among respondents reporting cost-related medication underuse in all 4 survey waves compared with 42% among respondents reporting no underuse, P < 0.001). There was no independent association of cost-related medication underuse with death.

CONCLUSIONS: In this nationally representative cohort, middle-aged and elderly adults with cardiovascular disease who reported cutting back on medication use because of cost were more likely to report being hospitalized over a subsequent 2-year period after they had reported medication underuse. The more extensively respondents reported cost-related underuse over time, the higher their adjusted predicted probability of subsequent hospitalization.

PB - 48 VL - 48 IS - 2 N1 - Using Smart Source Parsing Feb Comment In: Med Care. 2010 Feb;48(2):85-6 20057326 Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20068489?dopt=Abstract U2 - PMC3034735 U4 - Cardiovascular Diseases: drug therapy/Cardiovascular Diseases: economics/mortality/Health Care Costs/Services Accessibility: economics/Health Status Disparities/Hospitalization: economics/Hospitalization: statistics and numerical data/Logistic Models/Longitudinal Studies/Medication Adherence/Multivariate Analysis/Risk Factors ER - TY - JOUR T1 - The health effects of restricting prescription medication use because of cost. JF - Med Care Y1 - 2004 A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - Eby, Elizabeth L. A1 - A. Mark Fendrick A1 - Mohammed U Kabeto A1 - John D Piette KW - Aged KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Services Accessibility KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Patient Compliance KW - Prospective Studies KW - Risk KW - United States AB -

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.

PB - 42 VL - 42 IS - 7 N1 - Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15213486?dopt=Abstract U4 - Health Insurance/Health Care Costs/Prescription Fees/Female/Multivariate Analysis/Prospective Studies/United States/Health Status/Health Services ER -