|| Checking for direct PDF access through Ovid
Background and Objectives: Medication nonadherence is associated with increased risk of cardiovascular disease (CVD) events among patients with CVD. In 2014, many Americans gained the option of purchasing health insurance coverage and states gained the option of expanding Medicaid eligibility under the Affordable Care Act (ACA). Little is known regarding cost-related nonadherence (CRN) to medication among US stroke survivors after implementation of the ACA. We assessed CRN to medication by age, insurance, and time in a national sample of stroke survivors.Methods: Among 5,011 stroke survivors 45 or older responding to the National Health Interview Survey years 2011 to 2015, we examined CRN to medication within the last 12 months by age and insurance because Medicare eligibility begins at 65. We used logistic regression to adjust for socio-demographic and clinical factors. We compared results from 2014 to 2015 to those from 2011 to 2013 as well as to our previous investigation of age-related differences in CRN to medication from 2006 to 2010.Results: In 2015, 13% of US stroke survivors reported CRN to medication. From 2010 to 2015, the percentage of stroke survivors who were uninsured decreased from 7% to 3% overall (57% decrease) (P<0.001) and from 15% to 7% among survivors aged 45-64 (53% decrease) (P<0.001). From 2011-2013 to 2014-2015, the percentage of stroke survivors aged 45-64 with Medicaid coverage increased from 24% to 31% (P<0.01). From 2006 to 2015, CRN to medication remained stable among younger stroke survivors (Ptrend=0.19) and increased slightly among older stroke survivors (Ptrend=0.01)(Figure).Conclusions: Among stroke survivors who are aged 45-64 years, insurance coverage, namely Medicaid, has increased substantially while CRN to medication has remained stable. Federal programs to improve insurance availability and access to care may not be reducing CRN as intended, and a resulting large number of stroke survivors are at risk for subsequent events.