Abstract 13740: Cumulative Social Disadvantage and Cost-Related Medication Non-Adherence Among US Adults With Hypertension: The National Health Interview Survey 2014-2017

Abstract

Introduction: Less than 50% adherence is reported 1 year after initiating antihypertensives. We examined social disparities in cost-related medication non-adherence (CRN) by insurance and family income categories in adults with hypertension. Methods: We used National Health Interview Survey 2014-2017 data from adults who reported hypertension and were taking antihypertensive medications. Respondents reported their insurance plan and family income. A cumulative SDoH index was created by aggregating 45 determinants from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). Higher SDoH quartiles indicated greater disadvantage. CRN was present if an individual skipped medication to save money, took less medicine to save money, or delayed filling a prescription to save money in the last 12 months. Results: A total of 35,893 adults managed for hypertension were surveyed, with a mean age 62.48 [SD 14.24] years, female 51.3%). The prevalence of CRN was 9.5%. The uninsured (34.6%) and those with low income were most likely to report CRN. Regardless of insurance or income, higher SDoH quartile groups were more likely to report CRN. This trend was accentuated among the uninsured and the middle-income group. Adjusting for demographics and comorbidities, the least increment in the odds of CRN with SDoH quartiles was seen among Medicare beneficiaries and low-income: SDoH-Q4 was associated with OR = 8.47 (95%CI, 2.11, 33.93) for Medicare beneficiaries, and OR = 17.80 (95%CI, 7.91, 40.03) for low-income. The highest increment in the odds of CRN with SDoH quartiles were observed with the uninsured (OR = 22.89; 95%CI [4.91, 106.81]), and the middle-income group (OR = 21.57; 95%CI [13.78, 33.77]). Conclusion: While cumulative social disadvantage was associated with higher cost-related medication non-adherence among adults on medications for hypertension, this association was stronger in the uninsured, Medicaid beneficiaries, and the middle-income group.