The DOI matches its Crossref record; 26 of the 27 references it cites were found in a registry or an index.
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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“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].”
From Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study (2019) · cites this paper as [30]
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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“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].”
In the citing paper
“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
Cites
Patient-Physician Communication About Out-of-Pocket Costs
Alexander, G. C. (2003) · JAMA · doi:10.1001/jama.290.7.953 · Cited by 417
Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs
Berkowitz, S. A., Seligman, H. K., & Choudhry, N. K. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2014.01.002 · Cited by 386
Piette, J. D., Heisler, M., & Wagner, T. H. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.10.1782 · Cited by 349
Self-citationMeasuring concurrent adherence to multiple related medications.
Choudhry, N. K., Shrank, W. H., Levin, R., Lee, J. L.-Y., Jan, S. A., Brookhart, M. A., & Solomon, D. H. (2009) · PubMed · Cited by 342
The Intersection between Food Insecurity and Diabetes: A Review
Gucciardi, E., Vahabi, M., Norris, N., Monte, J. P. D., & Farnum, C. (2014) · Current Nutrition Reports · doi:10.1007/s13668-014-0104-4 · Cited by 318
Piette, J. D., Wagner, T. H., Potter, M. B., & Schillinger, D. (2004) · Medical Care · doi:10.1097/01.mlr.0000108742.26446.17 · Cited by 294
Self-citationCost-Related Medication Underuse
Piette, J. D., Heisler, M., & Wagner, T. H. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.16.1749 · Cited by 251
Self-citationFood insecurity is associated with diabetes self‐care behaviours and glycaemic control
Heerman, W. J., Wallston, K. A., Osborn, C. Y., Bian, A., Schlundt, D. G., Barto, S., & Rothman, R. L. (2015) · Diabetic Medicine · doi:10.1111/dme.12896 · Cited by 121
Vijayaraghavan, M., Jacobs, E. A., Seligman, H. K., & Fernández, A. (2011) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2011.0131 · Cited by 120
Marcum, Z. A., Zheng, Y., Perera, S., Strotmeyer, E. S., Newman, A. B., Simonsick, E. M., Shorr, R. I., Bauer, D. C., Donohue, J. M., & Hanlon, J. T. (2013) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2012.12.002 · Cited by 111
Cited by
Sorted by citations
Social determinants of health and diabetes: A scientific review
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2021) · Diabetes Care · doi:10.2337/dci20-0053 · Cited by 1,732
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s009 · Cited by 1,555
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s009 · Cited by 972
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2020
American Diabetes Association (2020) · Diabetes Care · doi:10.2337/dc20-s009 · Cited by 914
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s009 · Cited by 851
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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