Abstract
BACKGROUND: Cost-related nonadherence (CRN), that is, not taking medication as prescribed to save money, may remain disproportionately high among individuals with multiple chronic conditions, particularly during periods of economic stress, such as the COVID-19 pandemic. However, the impact of economic hardship 3 years after the pandemic on CRN levels among individuals with multiple chronic conditions is still largely unknown. OBJECTIVE: To examine changes in CRN prevalence in 2020 (pandemic) and 2021 to 2023 (post-pandemic years 1, 2, and 3) relative to 2019 (pre-pandemic) among adults with multiple chronic conditions in the United States. METHODS: This is a repeated cross-sectional study using data from the National Health Interview Survey, 2019-2023. Our study sample included 27,413 US adults aged 18 to 64 years with 2 or more of any of 14 chronic conditions and who were prescribed medication. CRN (dependent variable) is a binary measure with values "1" if respondents endorsed 1 of the 4 cost-saving behavior questions-not purchasing medicine refills, delaying refills, splitting pills, or skipping doses to save money-and "0" otherwise. Analyses include survey-weighted CRN prevalence estimates by year and linear probability models assessing prevalence changes in 2020-2023 relative to 2019, overall, and by multiple chronic conditions subgroups (2, 3, and ≥4 conditions). RESULTS: The overall CRN prevalence in 2019 was 18.9%, 16.7% in 2020, 13.5% in 2021, 14.5% in 2022, and 15.5% in 2023. CRN decreased in all years relative to 2019 but only significantly by 2.2% (P = 0.001) in 2021 and by 1.4% (P = 0.049) in 2022. The subgroup analysis shows variation in these results, with a significant reduction in CRN in 2021, relative to 2019, limited to those who reported 3 chronic conditions. CONCLUSIONS: Fewer adults with multiple chronic conditions reported CRN 1 and 2 years after the pandemic relative to the pre-pandemic in the United States, but those with 4 or more conditions remain vulnerable after the pandemic.