Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004-2014: a longitudinal study.
Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004-2014: a longitudinal study.
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DOI：
10.1136/bmjopen-2021-051480
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发表时间：
2022-05-06
期刊：
影响因子：
2.9
通讯作者：
Meltzer, David
中科院分区：
文献类型：
--
作者：
Zhang, James;Bhaumik, Deepon;Meltzer, David
在美国医疗体系以及全球范围内，药物获取障碍一直是一个持续存在且难以解决的挑战。与费用相关的药物不依从性（CRN）是衡量旨在避免费用的药物不依从行为的一个重要指标。针对老年人群体的CRN行为的纵向研究很少。
利用健康与退休研究每两年评估一次自我报告的CRN的纵向研究。
美国老年人群体。
2004年三个年龄组的美国人，分别为50 - 54岁（婴儿潮一代）、65 - 69岁（沉默的一代）和80岁及以上（最伟大的一代），并对其跟踪至2014年。
观察性研究，无干预措施。
2004年至2014年三个世代群体的纵向CRN比率。通过考虑三个群体随时间对CRN的重复测量，分别使用广义估计方程得出了一系列广泛变量的总体平均效应，这些变量包括社会人口统计学特征、收入、保险状况、日常生活活动能力（ADLs）和工具性日常生活活动能力（IADLs）受限情况以及合并症对CRN的影响。
婴儿潮一代、沉默的一代和最伟大的一代这三个群体分别有1925、2839和2666名受访者，在2004年分别代表1230万、820万和770万人。在控制人口统计学特征、收入、保险状况、功能状况和合并症的情况下，在所有三个世代群体中，年龄增长与报告CRN的可能性降低相关（p < 0.05）。与2004年相比，2014年所有三个世代群体中糖尿病、癌症、心脏病、中风的患病率更高，拥有医疗保险 - 医疗补助双重资格的受访者比例更高，拥有私人保险的比例更低（p < 0.05）。
CRN比率下降这一矛盾现象，与疾病负担、收入和保险状况无关，表明随着美国人年龄增长，人群的CRN行为发生变化，这对社会政策具有影响。
The 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. Longitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially. General population of older Americans. Three 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. Observational with no intervention. Longitudinal 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. The 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). The 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.
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