title: The effects of financial pressures on adherence and glucose control among racial/ethnically diverse patients with diabetes.
abstract: BACKGROUND
  The Affordable Care Act is designed to decrease the numbers of uninsured patients in U.S. However, even with insurance, patients who have financial hardships may have difficulty obtaining their medications because of cost issues.
  
  
  OBJECTIVE
  Among patients with type 2 diabetes, to examine the association between patients' self-reported financial pressures on cost-related medication non-adherence and glucose control. Additionally, to examine whether having insurance decrease the financial pressures of diabetes care.
  
  
  METHODS
  Racially/ethnically diverse patients (N = 1,361; 249 non-Hispanic whites, 194 Vietnamese, and 533 Mexican American) with type 2 diabetes were recruited from seven outpatient clinics for a cross-sectional, observational study.
  
  
  RESULTS
  Although both Vietnamese and Mexican-American patients reported having low annual incomes, more Mexican Americans reported the presence of financial barriers to getting medical care and perceived financial burden due to their diabetes, compared to whites and Vietnamese (p < 0.001). Over half (53.2%) of Mexican Americans reported cost-related non-adherence compared to 27.2% of white and 27.6% of Vietnamese patients (p < 0.001). Perceived financial burden was found to be associated with poor glucose control (HbA1c ≥8%), after adjusting for sociodemographic and health characteristics (aOR = 1.70, 95%CI 1.09-2.63), but not when adjusting for non-adherence. Similarly, a significant association between presence of financial barriers and HbA1c (aOR = 1.69, 95%CI 1.23-2.32) was attenuated with the inclusion of insurance status in the model. Being uninsured (aOR = 1.90, 95%CI 1.13-3.21) and non-adherent (aOR = 1.49, 95%CI 1.06-2.08) were each independently associated with HbA1c.
  
  
  CONCLUSIONS
  While having health insurance coverage eliminated some of the financial barriers associated with having diabetes, low-income patients still faced significant financial burdens. Thus, providing health insurance to more individuals is only the first step towards eliminating health disparities. It is important to address medication cost in order to improve medication adherence and glucose control.
authors: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California-Irvine, CA, USA. Qngo-metzger@hrsa.gov
authors: Quyen
authors: Q
authors: Ngo-Metzger
authors: Dara H
authors: DH
authors: Sorkin
authors: John
authors: J
authors: Billimek
authors: Sheldon
authors: S
authors: Greenfield
authors: Sherrie H
authors: SH
authors: Kaplan
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D017048:Health Care Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D016017:Odds Ratio; D044469:Racial Groups; D057566:Self Report; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin