A new observational study published in Thorax reveals that despite improvements in medication adherence trends, approximately one in six US adults with asthma still struggle to maintain their prescribed treatment regimens due to financial constraints. This persistent challenge affects an estimated 2.99 million Americans, highlighting a significant public health concern.
Cost-Related Non-Adherence Patterns
The study, analyzing data from the National Health Interview Survey (NHIS) between 2011 and 2022, found that 17.8% of US adults with asthma reported cost-related non-adherence (CRN). The manifestations of CRN varied among patients:
- 15.1% (2.54 million) delayed refilling prescriptions
- 12.4% (2.06 million) reduced medication doses
- 11.6% (1.95 million) skipped doses entirely
Demographic Disparities in Medication Access
The research uncovered significant disparities across different demographic groups. Non-Hispanic Black patients showed the highest rate of cost-related non-adherence at 20.3%, followed closely by Hispanic patients at 20.1%, while White patients reported 17.1%. Gender differences were also notable, with women (19.5%) more likely to report CRN compared to men (14.4%).
Age emerged as a significant factor, with patients over 60 showing the lowest rates of non-adherence compared to younger age groups. Adults aged 18-40 and 41-60 reported CRN rates of 21.5% and 18.7% respectively, significantly higher than their older counterparts.
Clinical Implications and Health Outcomes
The study revealed concerning correlations between cost-related non-adherence and adverse health outcomes. Patients who reported CRN faced:
- 95% higher risk of experiencing asthma attacks (adjusted OR: 1.95; 95% CI: 1.78-2.13)
- 63% increased likelihood of requiring emergency room visits (adjusted OR: 1.63; 95% CI: 1.44-1.84)
Dr. Chung-Hsuen Wu from Taipei Medical University, a lead study author, expressed concern about these findings: "You can see from our study that, compared with patients without cost-related non-adherence, patients with cost-related non-adherence are more likely to have asthma attacks and ER visits."
Healthcare Provider Implications
The findings underscore the importance of healthcare providers taking a more comprehensive approach to asthma management. The study authors recommend that clinicians:
- Actively discuss financial concerns with patients before initiating treatment
- Consider cost factors when developing treatment plans
- Explore collaborative approaches to understand patients' economic circumstances
- Implement strategies to improve medication accessibility
These results highlight the ongoing challenge of balancing optimal asthma management with healthcare affordability, suggesting a need for systemic changes to improve medication access for vulnerable populations.
