1 in 6 COPD US patients do not adhere to medication due to costs

Nonadherence tied to more symptoms and costs, hospitalizations, mortality

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by Andrea Lobo |

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A person enveloped by smoke is coughing.

One in six adults in the U.S. with chronic obstructive pulmonary disease (COPD) didn’t adhere to their medications due to costs, which is associated with a poor prognosis.

That’s according to a study that analyzed data from a U.S. survey of adults with COPD between 2013-2020. Patients younger than 65, women, and those with a lower income or lacking health insurance were more likely to report cost-related medication nonadherence, results showed.

“Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients,” the researchers wrote in “Cost-related medication nonadherence in adults with COPD in the United States 2013–2020,” which was published in BMC Public Health.

COPD is a chronic lung inflammatory disease where the airways become blocked, causing cough with mucus, wheezing, and shortness of breath.

“According to the World Health Organization (WHO), COPD is the third leading cause of chronic morbidity and mortality worldwide, including in the U.S. and China,” the researchers wrote. While it has no cure, proper medication and lifestyle changes can reduce some symptoms. The Global Initiative on Obstructive Lung Disease (GOLD) recommends patients have long-term therapy to improve prognosis, particularly by adhering to their medication.

“However, long-term medication adherence in patients with COPD is poor, which is less than 50% according to the WHO reports,” the researchers wrote. Nonadherence to medication is linked to increasing COPD symptoms, hospitalizations, healthcare expenditures, and mortality.

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What factors contribute to medication nonadherence?

Several factors may contribute to nonadherence, including medication costs, and a previous U.S. study shows economic disparities and inadequate insurance coverage negatively impact healthcare for people with COPD.

“Therefore, improving medication adherence and health outcomes in patients with COPD remains an urgent and elusive challenge for the global health community,” wrote the researchers, who sought to investigate the prevalence and characteristics of cost-related medication nonadherence in this patient population to offer recommendations about improving patient health and quality of life.

The researchers analyzed anonymous publicly available 2013-2020 data from the National Health Interview Survey, which is conducted annually by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics.

Among 253,577 adults included, 17,591 (6.9%) reported having COPD, “representing an estimated number of 14.38 million patients per year,” the researchers wrote. Among COPD patients, 90.5% completed the individual survey components for nonadherence to medication, with 18% reporting cost-related medication nonadherence.

“This equates to an average of 2.39 million … U.S. adults with COPD reporting CRN [cost-related medication nonadherence] each year from 2013 to 2020,” the researchers wrote.

CRN included skipping medication doses, taking less medication than prescribed, and/or delaying filling prescriptions to save costs.

The average rates of cost-related medication nonadherence decreased from 22% in 2013 to 14.6% in 2020. Similar trends were observed if patients were stratified by age.

A greater proportion of COPD patients younger than 65 reported cost-related medication nonadherence relative to older patients (24.4% vs. 10.5%). Younger patients were more than twice as likely to refuse prescribed medication (16.9% vs. 6.4%), take less medication than prescribed (17.9% vs. 7%), and delay filling a prescription to save costs (21.3% vs. 8.2%).

Statistical analyses that considered possible influencing factors showed adult patients younger than 65 were about 2.7 times more likely to not adhere to medication due to costs, compared with those age 65 or older.

Having a lower family income or lack of health insurance were each associated with a higher chance of cost-related nonadherence, by about three times. Women, current smokers, those with asthma, and those with two simultaneous health conditions were about 50% more likely to not adhere to their medication due to costs.

The findings showed that “in the U.S., one in six adults with COPD reported CRN,” wrote the researchers, who said “the influencing factors of CRN are multifaceted and [necessitate] more rigorous research.”

“Health policy interventions focusing on reducing drug costs, delaying disease progression, preventing exacerbations, and reducing the risk of comorbidities may improve the economic burden of COPD and its outcomes,” and “this report can serve as [a] reference for improving medication nonadherence,” they said.