Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006–2016

Abstract

Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.

An adapted model of cost-related medication nonadherence among older adult patients with chronic diseases: an Iranian qualitative study

“…Previous studies confirm that social and cultural barriers could worsen CRN behavior among patients with different chronic diseases [ 30 – 33 ]. Reports indicated an association between social capital and CRN among older adults [ 11 , 32 ]. Some other studies have emphasized the effects of employment status (unemployed, underemployed, employed), income, and access to non-employment-related resources (pensions, loans) on CRN [ 22 ].…”

“…Cost-related medication non-adherence (CRN) is defined as insufficient use of medications because of cost. It is generally agreed individuals are subject to CRN when they show one of the following behaviors during the past 3 or 12 months: (1) not filling or delay in filling a prescription to save money, (2) skipping doses or taking less medication than prescribed or splitting pills to make medicines last longer, (3) asking a doctor to prescribe lower-cost and affordable medication/s [ 6 , 8 , 9 , 11 , 12 ].…”