Abstract MP41: Cost-related Medication Nonadherence by Psychological Distress Status Among Adults With Hypertension in the US

Abstract

Objectives: Medication adherence is a major factor determining the effectiveness of hypertension management. Financial cost and psychological distress (PD) may influence medication adherence, but research in this field is lacking. This study investigated cost-related medication nonadherence (CRMN) and cost-reduction strategies (CRS) by PD status in US adults with hypertension. Methods: The study population included adults aged 18 years and older with self-reported hypertension (n=15,778) from the 2017 and 2018 National Health Interview Survey, a nationally representative health survey. CRMN was defined as persons having skipped medication, taking less medication than prescribed, or delaying a medication refill in the past 12 months to save money. CRS was defined as persons having asked a doctor for lower cost medication, bought prescription drugs from another country, or used alternative therapies in the past 12 months to save money. PD was based on a 6-item scale of the Kessler Psychological Distress Scale classified as no/low, mild/moderate, and severe distress. We calculated adjusted percentages of CRMN and CRS for each PD level. We calculated adjusted odds ratios (AOR) of both CRMN and CRS by PD status for overall and sub-population groups by age and sex. We controlled for race/ethnicity, education level, insurance status, household income, and cardiovascular risk factors. Results: Among the adults with hypertension, 10.4% reported CRMN, 24.0% reported CRS, 11.9% had mild/moderate and 6.0% had severe PD. Adjusted percentage of CRMN increased from 7.3% for no/low to 19.0% for mild/moderate and 28.7% for severe PD status (p<0.001); and adjusted percentage of CRS increased from 21.1% to 35.0% and 39.8%, respectively (p<0.001). These patterns hold for age and sex group with a higher percentage for younger (18-64 years) than for older (65 and older) age groups. Compared with patients with no/low PD, patients with mild/moderate and severe PD were more likely to report CRMN with an AOR of 2.81 (95% CI: 2.34-3.37) and 5.12 (4.17-6.30), respectively; and for CRS, the AOR was 1.93 (1.70-2.19) and 2.30 (1.91-2.76), respectively. These patterns were consistent for each age and sex group while the younger age group and women experienced more CRMN and CRS. Conclusions: The positive relationships between CRMN and PD, as well as CRS and PD suggest that uncontrolled PD could play a disruptive role in hypertension management. Addressing behavioral health among adults with hypertension may be important to achieving hypertension control goals.