Background

Prescription affordability is a key component of healthcare accessibility and a determinant of health outcomes. Prior studies indicate that up to 1 in 4 Americans report difficulty affording prescriptions.

Objective(s): This study aims to identify factors associated with cost-based prescription refusal.

Methods

We identified 17,869 study participants from the 2017 National Health Interview Survey who had been prescribed at least one medication in the past 12 months. The outcome was defined as inability to afford at least one prescription medication. Covariates included demographic data, medical history, and social attitudes. Logistic regression models were constructed to identify predictors of cost-based prescription refusal.

Results

Among 8223 study participants, 8.1% reported the inability to afford at least one prescription medication in the past 12 months. Twenty-seven covariates were correlated with prescription unaffordability, and 8 were selected by the LASSO: Income (Odds ratio (OR) 0.55), Concerned About Bills (OR 2.0), Emergency Department Visits past 12 months (OR 1.33), Dissatisfaction with Medical Care (OR 1.3), Seeking Insurance Through the Health Insurance Marketplace (OR 1.26), Feeling Sad Most of the Time (OR 1.24), History of Asthma (OR 1.26) and History of Diabetes (OR 1.24).

Conclusions

Prescription unaffordability remains a significant public health problem and is more common among low-income individuals and patients with, chronic medical conditions.

中文翻译：

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确定处方药负担不起的患病率和风险因素

背景

处方药的可负担性是医疗保健可及性的关键组成部分，也是健康结果的决定因素。先前的研究表明，多达四分之一的美国人表示难以负担处方药费用。

目的：本研究旨在确定与基于成本的处方拒绝相关的因素。

方法

我们从 2017 年全国健康访谈调查中确定了 17,869 名研究参与者，他们在过去 12 个月内至少服用过一种药物。结果被定义为无法负担至少一种处方药。协变量包括人口统计数据、病史和社会态度。构建逻辑回归模型以确定基于成本的处方拒绝的预测因子。

结果

在 8223 名研究参与者中，8.1% 的人表示在过去 12 个月内无力负担至少一种处方药。27 个协变量与处方药不可负担性相关，LASSO 选择了 8 个：收入（比值比 (OR) 0.55）、关注账单（OR 2.0）、过去 12 个月的急诊就诊（OR 1.33）、对医疗不满意护理 (OR 1.3)、通过健康保险市场寻求保险 (OR 1.26)、大部分时间感到悲伤 (OR 1.24)、哮喘史 (OR 1.26) 和糖尿病史 (OR 1.24)。

结论

处方药负担不起仍然是一个重大的公共卫生问题，并且在低收入个人和患有慢性疾病的患者中更为常见。