Approximately 1 in 6 US Adults With Asthma Report Non-Adherence to Medication Due to Cost

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The number of US adults who report not adhering to their asthma treatment because of costs remains high, despite declining trends in non-adherence, reports a recent observational study published in Thorax.¹ According to the authors, these findings suggest that health care providers should consider collaborative approaches to better understand patients’ financial or economic conditions and preferences prior to the initiation of treatment.^1,2

Uncontrolled asthma is believed to be caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence or inconsistent adherence to medications and treatments. Since economic conditions and asthma management have continued—and will continue—to change over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. To assess this, the study authors evaluated trends, prevalence, and determinants of CRN, as well as the impact these factors have on asthma control among adult patients with asthma in the US.¹

For this observational study, the investigators assessed data from the 2011 to 2022 National Health Interview Survey (NHIS). A joinpoint regression analysis was used to evaluate trends in the prevalence of CRN, and a multivariable logistic regression model was used to identify factors that were associated with CRN. Further, 2 additional multivariable logistic regression models were used to examine associations between CRN and asthma-related adverse events (AEs), including asthma attacks and emergency room (ER) visits related to asthma.²

A total of 30,793 adult patients aged 18 years and older with current asthma were enrolled from the NHIS and included in the study. The investigators noted that they defined “current asthma” as respondents who answered “yes” to the following questions: “Has a doctor or other health professional ever told you that you have asthma?” and “Do you still have asthma?” CRN was the primary study outcome and it was defined as an affirmative response to any of the following questions: “Did you skip medication doses to save money over the past 12 months?”; “Did you take less medication to save money over the past 12 months?”; and “Did you delay refilling medications to save money over the past 12 months?”¹

Additionally, asthma attacks were identified if patients responded “yes” to one question (“During the past 12 months, have you had an episode of asthma or an asthma attack?”). Similarly, ER visits for asthma were also defined by patients’ affirmative response to one question (“During the past 12 months, have you had to visit an ER or urgent care center because of asthma?”).¹

According to the findings, there was an observed declining trend in the prevalence of CRN among the enrolled patients. Despite this trend, approximately 1 in 6 adults with asthma were non-adherent to medications because of their cost. The enrolled population represented approximately 8.1% (19.38 million) of the US population. Overall, approximately 17.8% of US adults with asthma reported CRN, representing an estimated 2.99 million of the US population. Among the components of CRN, approximately 11.6% (1.95 million) reported skipping medication doses to save money, 12.4% (2.06 million) took less medication to save money, and 15.1% (2.54 million) delayed refilling their medications to save money.¹

Additionally, adult patients with asthma aged over 60 years were the least likely to report CRN compared with those aged 18 to 40 and 41 to 60 years (21.5% vs 18.7% and 21.5%, respectively; P < .01). Female patients were also more likely to report CRN compared with males (19.5% vs 14.4%, P < .01). Non-Hispanic Black patients (20.3%) were the most likely to report CRN compared with other Hispanic (20.1%) and White (17.1%) patients, as well as other (14.8%). Further, the results showed that adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted OR, 1.95; 95% CI 1.78-2.13) and ER visits because of asthma (adjusted OR, 1.63; 95% CI 1.44-1.84).¹

In a press release, study author Chung-Hsuen Wu, PhD, of Taipei Medical University in Taiwan, noted he was surprised to find that cost-related events are still a problem for patients with asthma, despite cost-related events decreasing in the past 12 years. "You can see from our study that, compared [with] patients without cost-related non-adherence, patients with cost-related non-adherence...are more likely to have asthma attacks and ER visits.”²

REFERENCES

1. Hung C-T, Erickson SR, Wu C-H. Cost-related non-adherence to medications among adults with asthma in the USA, 2011–2022. Thorax. Published Online First: 09 December 2024. doi:10.1136/thorax-2024-221778

2. Medpage Today. One in six adults with asthma didn't adhere to meds due to cost. News release. December 9, 2024. Accessed December 10, 2024. https://www.medpagetoday.com/pulmonology/asthma/113293?xid=nl_mpt_morningbreak2024-12-10&mh=6d2b5f4f91352444bdf817a9c17750bc&utm_source=Sailthru&utm_medium=email&utm_campaign=MorningBreak_121024&utm_term=NL_Gen_Int_Daily_News_Update_active