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Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes: Findings From the National Health Interview Survey
Open accessAbstract
Background: Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non–health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN. Methods: Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN. Results: Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05–1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5–1.67), and food insecurity (PR=1.30; 95% CI, 1.2–1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2–0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. Conclusions: Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
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“High out-of-pocket (OOP) drug costs are identified as a factor that limit initiation of and adherence to prescribed glucose lowering therapies.8,9,10,11,12”
From Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease (2023) · cites this paper as [9]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Medication costs can be a major source of stress for people with diabetes and contribute to worse medication-taking behavior (197); cost-reducing strategies may improve medication-taking behavior in some cases (198).”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [198]
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“Social determinants have also been linked to nonadherence, and a recent study using data from the National Health Interview Survey found that half of the adults with diabetes perceived financial stress, while one-fifth reported financial insecurity and food insecurity [30].”
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“Social determinants have also been linked to nonadherence, and a recent study using data from the National Health Interview Survey found that half of the adults with diabetes perceived financial stress, while one-fifth reported financial insecurity and food insecurity [30].”
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“In a study of patients with chronic disease, two-thirds of those who reported not taking medications as prescribed due to cost never shared this with their physician [30,31].”
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Citations
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Metadata
- Authors
- Patel, M. R., Piette, J. D., Resnicow, K., Kowalski-Dobson, T., & Heisler, M.
- Affiliations
- University of Michigan (US)
- Department of Health Behavior & Health Education, University of Michigan School of Public Health
- Corresponding author
- Patel, Minal R.
- Piette, John D.
- Kowalski-Dobson, Theresa
- Venue
- Medical Care
- Published
- 2016-08
- Volume
- 54
- Issue
- 8
- Pages
- 796-803
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC4945373
- OpenAlex
- W2408160586
- Cited by
- 143
- References
- 27
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 16 · 2023: 17 · 2022: 17 · 2021: 19 · 2020: 18 · 2019: 10 · 2018: 10 · 2017: 5 · 2016: 3
- FWCI
- 11.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Food Security and Health in Diverse Populations
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- cost-related nonadherence, diabetes mellitus, social determinants of health, financial stress, financial insecurity, food insecurity, low-cost medication, complementary and alternative medicine, medication adherence
- MeSH terms
- Cost Control, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Surveys, Humans, Insurance, Health, Male, Middle Aged, Patient Compliance, Self Care, Insurance Coverage, Social Determinants of Health
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