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Cost-Related Non-Adherence Declines for Asthma, More Action Needed
CRN declined from 23.2% to 13.1% between 2011 and 2022 but still affects around 2.5 million adults in the US.
Cost-related non-adherence (CRN) to asthma medication declined between 2011 and 2022 but remains an issue as affected patients are at higher risk for adverse outcomes.1
“Medication non-adherence is complex and multifactorial and represents a major issue in treating patients with asthma. Financial hardship is a major factor which leads to medication non-adherence. Previous studies suggest that individuals with a low income or low socioeconomic status were more likely to have asthma exacerbations.2 Patients might delay taking or even skip prescribed medications if they are unable to afford treatment costs. This phenomenon consequently results in CRN and adversely affects their asthma control,” lead investigator Chun-Tse Hung, School of Pharmacy, Taipei Medical University, Taiwan, and colleagues wrote.1
Hung and colleagues analyzed data from the United States (US) from 2011 to 2022 from the National Health Interview Survey conducted by the National Center for Health Statistics. They evaluated trends in CRN prevalence using joinpoint regression analysis and associated factors, including asthma attacks and emergency room (ER) visits for asthma, using a multivariable logistic regression model.
The investigators included a total of 30,793 adults with asthma, representing 8.1% of the total 19.38 million US adult population with asthma. They found that 17.8% of this population reported CRN – when extrapolated to the larger US adult population with asthma, this represents an estimated 2.99 million people. Specifically, 11.6% reporting CRN skipped medication doses to save money, 12.4% took less medication to save money, and 15.1% delayed refilling medications to save money.1
Investigators observed a declination in CRN prevalence in adults with asthma between 2011 and 2022 from 23.2% to 13.1% (average annual percentage change [AAPC], -5.0 [95% CI, -6.1 to -3.8]). Sensitivity analyses confirmed declinations in each type of CRN, with an AAPC of -6.5 (95% CI, -7.9 to -5.1) for skipping doses, -6.2 (95% CI, -7.3 to -5.1) for taking less medication, and -5.1 (95% CI, -6.2 to -4.0) for delaying refills. Participants residing in the South had the smallest decline in CRN prevalence (AAPC, −5.0 [95% CI, −7.0 to −3.2]).1
After covariate adjustment and multivariable logistic regression model analysis, Hung and colleagues found that patients with asthma who were younger, female, residents of the Midwest, South or West, with an educational level of less than high school, without health insurance coverage, with a family income of <400% of the FPL, a current or former smoker and with comorbidities had higher odds of reporting CRN.
Over half the patients reporting CRN experienced asthma attacks and around 19.0% reporting CRN visited the ER for asthma. Importantly, the study further confirmed that adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted odds ratio [OR], 1.95 [95% CI, 1.78-2.13) and ER visits for asthma (adjusted OR, 1.63 [95% CI, 1.44-1.84]).1
“Since asthma is one of the leading chronic diseases, the burden in CRN highlights the need for appropriate policies and social support to address such problems,” Hung and colleagues concluded.1
