title: The effect of cost on adherence to prescription medications in Canada.
abstract: BACKGROUND
  Many patients do not adhere to treatment because they cannot afford their prescription medications, putting them at increased risk of adverse health outcomes. We determined the prevalence of cost-related nonadherence and investigated its associated characteristics, including whether a person has drug insurance.
  
  
  METHODS
  Using data from the 2007 Canada Community Health Survey, we analyzed the responses of 5732 people who answered questions about cost-related nonadherence to treatment. We determined the national prevalence of cost-related nonadherence and used logistic regression to evaluate the association between cost-related nonadherence and a series of demographic and socioeconomic variables, including province of residence, age, sex, household income, health status and having drug insurance.
  
  
  RESULTS
  Cost-related nonadherence was reported by 9.6% (95% confidence interval [CI] 8.5%-10.6%) of Canadians who had received a prescription in the past year. In our adjusted model, we found that people in poor health (odds ratio [OR] 2.64, 95% CI 1.77-3.94), those with lower income (OR 3.29, 95% CI 2.03-5.33), those without drug insurance (OR 4.52, 95% CI 3.29-6.20) and those who live in British Columbia (OR 2.56, 95% CI 1.49-4.42) were more likely to report cost-related nonadherence. Predicted rates of cost-related nonadherence ranged from 3.6% (95% CI 2.4-4.5) among people with insurance and high household incomes to 35.6% (95% CI 26.1%-44.9%) among people with no insurance and low household incomes.
  
  
  CONCLUSIONS
  About 1 in 10 Canadians who receive a prescription report cost-related nonadherence. The variability in insurance coverage for prescription medications appears to be a key reason behind this phenomenon.
authors.affiliation: The Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC. mlaw@chspr.ubc.ca
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.forename: Lucy
authors.initials: L
authors.lastname: Cheng
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Dhalla
authors.forename: Deborah
authors.initials: D
authors.lastname: Heard
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002648:Child; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007182:Income; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D055553:Prescription Drugs / Q000191:economics; D015995:Prevalence; D012737:Sex Factors; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs