title: Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes: Findings From the National Health Interview Survey.
abstract: Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non-health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN.
  
  
  
  Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN.
  
  
  
  Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05-1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5-1.67), and food insecurity (PR=1.30; 95% CI, 1.2-1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2-0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN.
  
  
  
  Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
authors.affiliation: *Department of Health Behavior & Health Education, University of Michigan School of Public Health †Department of Internal Medicine and Health Behavior and Health Education, Ann Arbor, MI.
authors.forename: Minal R
authors.initials: MR
authors.lastname: Patel
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Kenneth
authors.initials: K
authors.lastname: Resnicow
authors.forename: Theresa
authors.initials: T
authors.lastname: Kowalski-Dobson
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D003363:Cost Control / Q000379:methods; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012648:Self Care / Q000191:economics*; D064890:Social Determinants of Health