title: Compromised access to prescriptions and medical care because of cost among US adults with arthritis.
abstract: BACKGROUND
  Study objectives were to: 1) determine the magnitude of three outcomes (prescription unaffordable, care delayed and needed care not obtained) related to cost-attributable compromised medical care access among US adults ≥18 years with and without arthritis and 2) identify US adults with arthritis with the highest levels of these outcomes.
  
  
  METHODS
  We analysed 2009-2011 US National Health Interview Survey data and estimated prevalence of outcomes by arthritis status and, among people with arthritis, by socio-demographic, medical care access and health status characteristics. Unadjusted and multivariable (MV) adjusted (prevalence ratios) PRs quantified associations between each outcome and arthritis status, and, among people with arthritis, selected characteristics. Number and proportion of adults with arthritis without health insurance coverage were estimated.
  
  
  RESULTS
  Outcomes were more prevalent (statistically-significant) among those with arthritis than those without: prescription unaffordable = 14% (9%), care delayed = 14% (11%) and needed care not obtained = 11% (8%). Outcomes were marginally more likely (statistically significant) among adults with arthritis than those without (range MV PRs = 1.2-1.3). Among those with arthritis, the uninsured had the highest prevalence of, and were most likely to have, each outcome (MV PRs: prescription unaffordable = 3.6 (95% confidence interval [CI] = 3.6-4.4), delayed care = 4.7 (95% CI = 3.9-5.7) and needed care not obtained = 5.9 (95% CI = 4.7-7.5) (referent: those with both public and private coverage)). An estimated 4.5 million adults with arthritis were uninsured.
  
  
  CONCLUSIONS
  Cost-attributable compromised access is common among US adults with arthritis; they are also slightly more likely than those without arthritis to have compromised care. Compromised access is highest among the uninsured. For those with limited access, convenient, inexpensive and proven community-based strategies that improve physical and psychosocial health may be especially practical.
authors.affiliation: Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. lmurphy1@cdc.gov
authors.forename: Louise B
authors.initials: LB
authors.lastname: Murphy
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Theis
mesh_terms: D000328:Adult; D001168:Arthritis / Q000191:economics / Q000628:therapy*; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000191:economics*; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States