title: Medication Nonadherence: The Role of Cost, Community, and Individual Factors.
abstract: To explain the association of out-of-pocket (OOP) cost, community-level factors, and individual characteristics on statin therapy nonadherence.
  
  
  
  BlueCross BlueShield of Texas claims data for the period of 2008-2011.
  
  
  
  A retrospective cohort of 49,176 insured patients, aged 18-64 years, with at least one statin refill during 2008-2011 was analyzed. Using a weighted proportion of days covered ratio, differences between adherent and nonadherent groups are assessed using chi-squared tests, t-tests, and a clustered generalized linear model with logit link function.
  
  
  
  Statin therapy adherence, measured at 48 percent, is associated with neighborhood-level socioeconomic factors, including race/ethnicity, educational attainment, and poverty level. Individual characteristics influencing adherence include OOP medication cost, gender, age, comorbid conditions, and total health care utilization.
  
  
  
  This study signifies the importance of OOP costs as a determinant of adherence to medications, but more interestingly, the results suggest that other socioeconomic factors, as measured by neighborhood-level variables, have a greater association on the likelihood of adherence. The results may be of interest to policy makers, benefit designers, self-insured employers, and provider organizations.
authors: School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
authors: Ibrahim
authors: I
authors: Abbass
authors: School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
authors: Lee
authors: L
authors: Revere
authors: School of Business, University of Houston Clear Lake, League City, TX.
authors: Jordan
authors: J
authors: Mitchell
authors: School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
authors: Ajit
authors: A
authors: Appari
mesh_terms: D000293:Adolescent; D000328:Adult; D054598:Blue Cross Blue Shield Insurance Plans; D016527:Drug Costs; D005260:Female; D005382:Financing, Personal; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D007345:Insurance Claim Review; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D013781:Texas; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Medication adherence; cost sharing; health care utilization; out-of-pocket expense