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Cost-Related Nonadherence and Mortality in Patients With Chronic Disease: A Multiyear Investigation, National Health Interview Survey, 2000–2014
ORIGINAL RESEARCH — Volume 17 — December 3, 2020
PEER REVIEWED
Conceptual model of the relationship between cost-related nonadherence and mortality. Boxes (measured variables) and clouds (unmeasured variables) represent determinants of health care access and utilization, eg, Andersen’s Model (15), and components shown in bold are the primary focus of the current study. Skipping medication means forgoing medication doses altogether as a result of cost, substitution of medication means taking cheaper alternative medications, and delaying medication means delaying taking doses or waiting to fill prescriptions to make medication last longer and save money.This flowchart is a conceptual model of the relationship between cost-related nonadherence and mortality. Perceived need, health care access, income, health insurance, and socioeconomic status are shown as determinants of cost constraints and financial worry. Cost constraints and financial worry lead to skipping medication, delaying medication, and substituting medication, all of which are types of cost-related nonadherence. Cost-related nonadherence leads to worse health, followed by the outcome of premature mortality.
Figure 1.
Conceptual model of the relationship between cost-related nonadherence and mortality. Boxes (measured variables) and clouds (unmeasured variables) represent determinants of health care access and utilization, eg, Andersen’s Model (15). Skipping medication means forgoing medication doses altogether as a result of cost, substitution of medication means taking cheaper alternative medications, and delaying medication means delaying taking doses or waiting to fill prescriptions to make medication last longer and save money.
A directed acyclic graph depicts confounding relationships between cost-related nonadherence and premature mortality. The variables of age, education, race, and sex, and toward insurance, income, body mass index, and smoking, which with other chronic conditions, are shown to determine cost-related nonadherence and premature mortality. Age, sex, race, income, insurance, education, and additional chronic conditions are shown to confound associations between cost-related nonadherence and premature mortality.
Figure 2.
Directed acyclic graph depicting hypothesized causal interrelations between cost-related nonadherence, sociodemographic characteristics, and premature mortality.
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