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Background <p>Stroke is a leading cause of morbidity and mortality worldwide, with high recurrence rates that necessitate consistent medication adherence. Cost-related medication nonadherence (CRN) poses a significant barrier to effective secondary prevention, yet few studies have comprehensively examined CRN among stroke survivors, particularly regarding recent trends and sociodemographic determinants.</p> Objectives <p>This study evaluated the prevalence of CRN and identified sociodemographic factors associated with CRN among U.S. adults who self-reported stroke, using data from the 2020–2023 National Health Interview Survey. We also examined interactions between race/ethnicity, insurance status, and family income.</p> Methods <p>We conducted a cross-sectional analysis of 3,824 stroke survivors aged 18 years and older. CRN was defined as skipping doses, taking less medication, delaying prescription refills, or failing to fill prescriptions due to cost. Chi-square test and weighted multivariable logistic regression models were used to assess associations between CRN and sociodemographic factors, including age, gender, race/ethnicity, education, marital status, insurance status, family income, and number of children.</p> Results <p>The prevalence of CRN was 13.1%. Uninsured individuals had higher odds of CRN (OR = 4.0, <i>p</i> &lt; .001) than insured participants. Younger adults (18–40 years: OR = 2.4, <i>p</i> &lt; .01; 41–64 years: OR = 3.0, <i>p</i> &lt; .001) and females (OR = 1.3, <i>p</i> &lt; .05) were more likely to report CRN. High-income individuals had lower odds (OR = 0.4, <i>p</i> &lt; .001), while middle-income participants had slightly higher odds (OR = 1.4, <i>p</i> &lt; .05). Exploratory analyses suggest differences in CRN across subgroups defined by race/ethnicity, income, and insurance status.</p> Conclusion <p>CRN affects a substantial proportion of U.S. stroke survivors, with insurance coverage, age, sex, and income emerging as consistent determinants. Observed heterogeneity across sociodemographic groups underscores the complexity of cost-related barriers and highlights the need for equity-focused interventions, particularly those addressing insurance gaps and financial burden among younger and economically vulnerable stroke survivors.</p>

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Cost-Related Medication Nonadherence Among Adults with Stroke in the United States: Insight from the 2020–2023 National Health Interview Survey

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Rockson Ansong,
  • Grace Kyei,
  • Dennis Miezah,
  • Musah Abubakari,
  • Evans Kyei

摘要

Background

Stroke is a leading cause of morbidity and mortality worldwide, with high recurrence rates that necessitate consistent medication adherence. Cost-related medication nonadherence (CRN) poses a significant barrier to effective secondary prevention, yet few studies have comprehensively examined CRN among stroke survivors, particularly regarding recent trends and sociodemographic determinants.

Objectives

This study evaluated the prevalence of CRN and identified sociodemographic factors associated with CRN among U.S. adults who self-reported stroke, using data from the 2020–2023 National Health Interview Survey. We also examined interactions between race/ethnicity, insurance status, and family income.

Methods

We conducted a cross-sectional analysis of 3,824 stroke survivors aged 18 years and older. CRN was defined as skipping doses, taking less medication, delaying prescription refills, or failing to fill prescriptions due to cost. Chi-square test and weighted multivariable logistic regression models were used to assess associations between CRN and sociodemographic factors, including age, gender, race/ethnicity, education, marital status, insurance status, family income, and number of children.

Results

The prevalence of CRN was 13.1%. Uninsured individuals had higher odds of CRN (OR = 4.0, p < .001) than insured participants. Younger adults (18–40 years: OR = 2.4, p < .01; 41–64 years: OR = 3.0, p < .001) and females (OR = 1.3, p < .05) were more likely to report CRN. High-income individuals had lower odds (OR = 0.4, p < .001), while middle-income participants had slightly higher odds (OR = 1.4, p < .05). Exploratory analyses suggest differences in CRN across subgroups defined by race/ethnicity, income, and insurance status.

Conclusion

CRN affects a substantial proportion of U.S. stroke survivors, with insurance coverage, age, sex, and income emerging as consistent determinants. Observed heterogeneity across sociodemographic groups underscores the complexity of cost-related barriers and highlights the need for equity-focused interventions, particularly those addressing insurance gaps and financial burden among younger and economically vulnerable stroke survivors.