Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004–2014: a longitudinal study

Abstract

ObjectivesThe access barrier to medication has been a persistent and elusive challenge in the US healthcare system and around the globe. Cost-related medication non-adherence (CRN) is an important measure of medication non-adherence behaviours that aim to avoid costs. Longitudinal study of CRN behaviours for the ageing population is rare.DesignLongitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially.SettingGeneral population of older Americans.ParticipantsThree cohorts of Americans aged between 50 and 54 (baby boomers), 65–69 (the silent generation) and 80 or above (the greatest generation) in 2004 who were followed to 2014.InterventionObservational with no intervention.Primary and secondary outcome measuresLongitudinal CRN rates for three generational cohorts from 2004 to 2014. Population-averaged effects of a broad set of variables including sociodemographics, income, insurance status, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and comorbid conditions on CRN were derived using generalised estimating equation by taking into account repeated measurements of CRN over time for the three cohorts, respectively.ResultsThe three cohorts of baby boomer, the silent generation and the greatest generation with 1925, 2839 and 2666 respondents represented 12.3 million, 8.2 million and 7.7 million people in 2004, respectively. Increasing age was associated with decreasing likelihood of reporting CRN in all three generational cohorts (p<0.05), controlling for demographics, income, insurance status, functional status and comorbid conditions. All three generational cohorts had a higher prevalence of diabetes, cancer, heart conditions, stroke, a higher percentage of respondents with Medicare-Medicaid dual eligibility and lower percentage with private insurance in 2014 compared with 2004 (p<0.05).ConclusionThe paradox of decreasing CRN rates, independent of disease burden, income and insurance status, suggests populations’ CRN behaviours change as Americans age, bearing implications to social policy.

Association of Supplemental Nutrition Assistance Program participation duration with cost‐related medication non‐adherence and emergency department visits

“…In contrast to nonelderly adults, SNAP participation for <12 months was not related to CRN in elderly adults. The greater perceived value of medications (Zhang et al., 2022) among elderly adults may explain the current finding. Further, compared to nonelderly adults, elderly adults in the current study had lower CRN rates; a finding that may be attributed to higher rates of health insurance coverage, possibly via Medicare, among elderly adults.…”

Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence

“…The study was also limited by a relatively short follow-up period. Future studies should be directed toward understanding the long-term CRN trajectory by incorporating time-varying covariates 25 . Although CRN did not explicitly elicit out-of-pocket payments for drugs, future research should explore the impact of varying copayments on CRN.…”

“…There are a few nationally representative surveys that carry questionnaires on CRN, such as the Medicare Current Beneficiary Survey, the Health and Retirement Survey, the National Health Interview Survey, and the National Financial Capability Study. [21][22][23][24] Among these, however, cross-sectional design prevents the development of longitudinal measures of persistent CRN behaviors, biennial design makes it difficult to ascertain the detailed gravity of patients' CRN behavior beyond a general generational trend, 25 and rotating panel design significantly limits a survey's utility in studying the longitudinal aspects of CRN.…”

Factors associated with the incidence and the expenditure of self-medication among middle-aged and older adults in China: A cross-sectional study

“…This can be partly explained by the worse health status of older adults, who were prone to multiple chronic diseases and therefore require greater medication expenditure. On the other hand, as individual’s age and their disease burden increase, their perceptions of the value of medication may also convert with the reduction of their remaining lives, making them change their consumption patterns and exhaust their life savings on medications ( 38 ). The last factor significantly associated with both total and OOP pharmaceutical expenditure of self-medication was residence.…”