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Research ArticleOriginal Research

The Role of Gender in Cost-Related Medication Nonadherence Among Patients with Diabetes

Soumitra S. Bhuyan, Olayinka Shiyanbola, Pallav Deka, Oluwaseyi O. Isehunwa, Aastha Chandak, Sean Huang, Yang Wang, Jay Bhatt, Lu Ning, Wang Jun Lin, David Wyant, Satish Kedia and Cyril F. Chang
The Journal of the American Board of Family Medicine September 2018, 31 (5) 743-751; DOI: https://doi.org/10.3122/jabfm.2018.05.180039
Soumitra S. Bhuyan
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Olayinka Shiyanbola
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Pallav Deka
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Oluwaseyi O. Isehunwa
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Aastha Chandak
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Sean Huang
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Yang Wang
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Jay Bhatt
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Lu Ning
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Wang Jun Lin
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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David Wyant
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Satish Kedia
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Cyril F. Chang
School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).
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Abstract

Objective: Under 50% of type 2 diabetic patients achieve the recommended glycemic control. One barrier to glycemic control is patients' cost-related nonadherence to medications. We hypothesize gender differences in medication nonadherence due to costs among diabetic patients.

Methods: US National Health Interview Survey (2011 to 2014) data yielded 5260 males and 6188 females with diabetes for over a year. We applied 2 analytic methods (A and B below) across multiple outcome measures (1 to 4) of medication nonadherence due to cost. The key independent variable was participant's gender.

Results: Across methods and measure, females consistently report significantly higher rates of medication nonadherence due to costs. Pearson's χ2 showed that female patients were more likely to (1) skip medication (13.5%–10.2%; P < .001), take less than prescribed medication (13.9%–10.5%; P < .001), delay filling prescriptions (16.8%–12.5%; P < .001), and ask doctors to prescribe lower-cost alternative medications (31.8%–28.0%; P < .001). Controlling for covariates, logistic regression models found females more likely to skip medication (OR, 1.30; 95% CI, 1.09–1.55), take less than prescribed medication (OR, 1.26; 95%, CI, 1.06–1.50), delay filling prescriptions, (OR, 1.29; 95% CI, 1.11–1.50), and request lower-cost medication (OR, 1.17; 95% CI, 1.04–1.32). Our results report other factors that influence medication adherence, including socioeconomic and health status variables.

Conclusions: A significant gender-based disparity exists on cost-related nonadherence of medication among diabetic patients. Health care providers and policy-makers should pay close attention to find ways to address cost-related nonadherence of medication among patients with chronic illness, especially among female patients.

  • Blood Glucose
  • Diabetes Mellitus
  • Drug Costs
  • Health Expenditures
  • Medication Adherence
  • Outcome Measure
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The Journal of the American Board of Family     Medicine: 31 (5)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 5
September-October 2018
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The Role of Gender in Cost-Related Medication Nonadherence Among Patients with Diabetes
Soumitra S. Bhuyan, Olayinka Shiyanbola, Pallav Deka, Oluwaseyi O. Isehunwa, Aastha Chandak, Sean Huang, Yang Wang, Jay Bhatt, Lu Ning, Wang Jun Lin, David Wyant, Satish Kedia, Cyril F. Chang
The Journal of the American Board of Family Medicine Sep 2018, 31 (5) 743-751; DOI: 10.3122/jabfm.2018.05.180039

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The Role of Gender in Cost-Related Medication Nonadherence Among Patients with Diabetes
Soumitra S. Bhuyan, Olayinka Shiyanbola, Pallav Deka, Oluwaseyi O. Isehunwa, Aastha Chandak, Sean Huang, Yang Wang, Jay Bhatt, Lu Ning, Wang Jun Lin, David Wyant, Satish Kedia, Cyril F. Chang
The Journal of the American Board of Family Medicine Sep 2018, 31 (5) 743-751; DOI: 10.3122/jabfm.2018.05.180039
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Keywords

  • Blood Glucose
  • Diabetes Mellitus
  • Drug Costs
  • Health Expenditures
  • Medication Adherence
  • Outcome Measure

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