The differential rates in cost-related non-adherence to medical care by gender in the US adult population

Abstract

Background: Cost-related non-adherence (CRN) to medical care is a persistent challenge in healthcare in the US. Gender is a key determinant of many healthcare behaviors and outcomes. Understanding variation in CRN by gender may provide opportunities to reduce disparities and improve outcomes.

Aims: This study aims to examine the differential rates in CRN by gender across a spectrum of socio-economic factors among the adult population in the US.

Method: Data from the 2015 National Financial Capability Study (NFCS) were used for this study. CRN is identified if a respondent indicated not filling a prescription for medicine because of the cost and/or skipping a medical test, treatment, or follow-up recommended by a doctor because of the cost in the past 12 months. The differential rates in CRN by gender were assessed across socio-economic strata. A multivariable logistic regression analysis was performed to evaluate the difference in CRN rates by gender, controlling for potential confounders.

Results: A total of 26,287 adults were included in the analyses. Overall, the weighted CRN rate in the adult population is 19.8% for men and 26.2% for women. There was a clear pattern of differential rates in CRN across socio-economic strata by gender. Overall, men were less likely to report CRN (AOR = 0.74; 95% CI = 0.69–0.79), controlling for other risk factors.

Conclusions: More research is needed to understand the behavioral aspects of gender difference in CRN. Patient-centered healthcare needs to take gender difference into account when addressing cost-related non-adherence behavior.

Keywords:

• Cost-related non-adherence
• gender
• access to care
• disparities

Transparency

Declaration of funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of financial/other interests

None of the authors have any potential financial conflict of interest. JXZ and JMC have an ownership interest in Chicago MedInfo Group, LLC. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgement

We thank the anonymous reviewers for their careful reading of our manuscript and detailed comments.