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Health illiteracy, low income drive medication nonadherence in type 2 diabetes
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Unintentional and intentional nonadherence to medications appear to be driven by different factors in medically underserved patients with type 2 diabetes, according to recent study findings published in The Diabetes Educator.
Jessica H. Fan, of the department of surgery at Washington University School of Medicine and colleagues evaluated 208 patients with type 2 diabetes from the Barnes-Jewish Center for Outpatient Health primary care clinic in St. Louis between July 2013 and April 2014. Data on self-reported health literacy and medication adherence were collected through written or verbally administered questionnaires. Insurance status, medication regimen and depressive symptom data were collected through patient medical records.
Bivariate analyses demonstrated an association between limited health literacy and increased overall nonadherence (P = .037). Additionally, increased age was found to be associated with lower overall nonadherence (P = .002) but with increased unintentional nonadherence (P = .018). Depression (P = .049) was associated with a higher likelihood of unintentional nonadherence, whereas an income of less than $20,000 (P = .033) was associated with a higher likelihood of intentional nonadherence.
Multivariable analysis of overall nonadherence did not reveal a significant association with nonadherence and health literacy; however, age was found to be a significant covariate with overall nonadherence lower among older patients (P = .027). Unintentional nonadherence was more common among those with limited health literacy (P = .048). Additionally, in this model, older age was associated with lower unintentional nonadherence (P = .038).
An income of less than $20,000 was associated with a greater likelihood of intentional nonadherence compared with those with an income greater than $20,000 (P = .042). Sex, race, educational level, insurance status, depression and complexity of medication regimen were not significantly associated with any of the nonadherence outcomes in this model.
“Overall, our results show that health literacy is related to unintentional medication nonadherence, potentially affecting a large number of adults with limited health literacy. ... Cost burdens for diabetes patients must also be considered, particularly as patients with low income may be more likely to have limited health literacy,” the researchers wrote. – by Jennifer Byrne
Disclosure: Fan reports receiving funding from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Please see the full study for a list of all other authors’ relevant financial disclosures.
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