Unemployment barrier to antidiabetic medication adherence

By Sally Robertson, B.Sc.Sep 5 2012

People with diabetes are less likely to adhere to their oral antidiabetic (OAD) medication if they are unemployed, report researchers.

"Workforce participation for adults with diabetes demands the attention of public policymakers," write Mary Davis-Ajami (University of Maryland School of Nursing, Baltimore, USA) and colleagues in Health Outcomes Research in Medicine.

"Healthcare providers need standard processes for identifying individuals facing financial pressure and their vulnerability to lower medication adherence," says the team.

In an analysis of pooled data available for 2256 individuals with diabetes who participated in the Household Component of the Medical Expenditure Panel Survey (MEPS, 2001-2007), the team found that 34% were jobless when initially interviewed, with 29% remaining jobless throughout four further interviews carried out during the study period.

Overall, approximately 55% of the population did not adhere to their OAD medication regimen, as defined by a proportion of days covered (PDC) per interview of less than 0.80.

Respondents who reported being jobless showed a 16% reduction in PDC compared with employed individuals, and were 25% less likely to meet or exceed the 0.80 PDC threshold for being considered adherent, after adjustment for potential confounders.

"Pharmacological nonadherence shows associations with disease progression, complications, hospitalizations, premature disability, and mortality," warn the researchers. "Joblessness in working-age adults with diabetes deserves policy considerations."

Davis-Ajami et al suggest that job losses as well as length of unemployment could be assessed in tandem with other financial measures that assess income, the affordability of medications, medical supplies, and services.

Additionally, existing pharmacologic nonadherence risk-assessment tools need further refinement and researchers should continue assessing optimal medication adherence thresholds with a view to identifying areas resulting in suboptimal disease management, suggests the team.

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