{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:18:56Z","timestamp":1785435536022,"version":"3.56.0"},"reference-count":50,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"unspecified","delay-in-days":85,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1463423626101054_as1\">\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>In the US, cardiovascular diseases (CVD) are the leading cause of death and disability. Cost-related medication non-adherence (CRMN) can have serious consequences and worsen CVD outcomes. We examined the relationship between CVD risk factors and CRMN among US adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1463423626101054_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>CDC\u2019s 2019\u20132021 National Health Interview Survey (NHIS) data were used to examine CRMN among adults, categorized into three groups based on reported risk factors. We used chi-square tests, and\u00a0logistic regression to determine factors associated with CRMN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1463423626101054_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 49,464 participants, young, unmarried individuals, females, less educated, and participants from the South had higher CRMN than older, married individuals, males, and those with higher education residing in the other regions. Current smokers and those with more CVD risk factors also reported higher CRMN than former and never-smokers. Conversely, those aged 65 or older, with high-income, and excellent self-rated health had lower CRMN than younger participants, low-income families, and those with poor self-rated health. Public insurance and Medicaid participants had lower CRMN than uninsured (OR 0.13, 95% CI, 0.04\u20130.45, and OR 0.24, 95% CI, 0.15\u20130.36). Stratified analysis by diabetes, hypertension, and hyperlipidemia, revealed participants with high-income had lower odds of CRMN (OR 0.38, 95% CI, 0.28\u20130.50; OR 0.39, 95% CI, 0.28\u20130.58; OR 0.37, 95% CI, 0.27\u20130.51 respectively) than those with lower- incomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1463423626101054_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Adults under 65 with more CVD risk factors and lacking insurance coverage are at higher risk of CRMN. Therefore, strengthening prescription drug coverage and targeted interventions are necessary to reduce CRMN among those with cardiovascular risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1463423626101054","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:11:51Z","timestamp":1774599111000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Factors affecting cost-related medication non-adherence among US population with cardiovascular risk factors"],"prefix":"10.1017","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4267-7533","authenticated-orcid":false,"given":"Nikhila","family":"Gandrakota","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"},{"id":[{"id":"https:\/\/ror.org\/03xjacd83","id-type":"ROR","asserted-by":"publisher"}],"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9504-2240","authenticated-orcid":false,"given":"Manju","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health: Emory University Rollins School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya","family":"Sudireddy","sequence":"additional","affiliation":[{"name":"UMass Chan Medical School TH Chan School of Medicine: University of Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6722-7846","authenticated-orcid":false,"given":"Megha K.","family":"Shah","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"S1463423626101054_ref40","doi-asserted-by":"crossref","unstructured":"Cawley, J , Biener, A , Meyerhoefer, C , Ding, Y , Zvenyach, T , Smolarz, BG and Ramasamy, A (2021) Direct medical costs of obesity in the United States and the most populous states. Journal of Managed Care & Specialty Pharmacy 27. https:\/\/doi.org\/10.18553\/jmcp.2021.20410","DOI":"10.18553\/jmcp.2021.20410"},{"key":"S1463423626101054_ref10","unstructured":"Hennein, R , Hwang, S-J , Au, R , Levy, D , Muntner, P , Fox, CS and Ma, J (2017) Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study - Hennein - 2018 - Internal Medicine Journal - Wiley Online Library [WWW Document]. Available at https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.13687 (accessed 25 September 2024)."},{"key":"S1463423626101054_ref11","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2019-213435"},{"key":"S1463423626101054_ref16","unstructured":"Lochner, K and Cox, C (2012) Chronic Conditions Chartbook: 2012 Edition | CMS [WWW Document]. Available at https:\/\/www.cms.gov\/research-statistics-data-and-systems\/statistics-trends-and-reports\/chronic-conditions\/2012chartbook (accessed 25 September 2024)."},{"key":"S1463423626101054_ref17","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001458"},{"key":"S1463423626101054_ref4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.118.313220"},{"key":"S1463423626101054_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2017.02.008"},{"key":"S1463423626101054_ref27","unstructured":"Trends in High School Dropout and Completion Rates in the United States [WWW Document] (2024) Available at https:\/\/nces.ed.gov\/programs\/dropout\/intro.asp (accessed 25 September 2024)."},{"key":"S1463423626101054_ref42","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-021-01598-w"},{"key":"S1463423626101054_ref31","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0668"},{"key":"S1463423626101054_ref54","unstructured":"340B Drug Pricing Program | HRSA (n.d.) [WWW Document]. Available at https:\/\/www.hrsa.gov\/opa (accessed 25 September 2024)."},{"key":"S1463423626101054_ref33","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2017.1326383"},{"key":"S1463423626101054_ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01400-3"},{"key":"S1463423626101054_ref44","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-018-0921-z"},{"key":"S1463423626101054_ref12","unstructured":"Khavjou, O , Phelps, D and Leib, A (2016) Projections-of-CVD-Prevalence-and-Costs-2015-2035.pdf [WWW Document]. Available at https:\/\/www.heart.org\/-\/media\/Files\/About-Us\/Policy-Research\/Fact-Sheets\/Public-Health-Advocacy-and-Research\/Projections-of-CVD-Prevalence-and-Costs-2015-2035.pdf (accessed 25 September 2024)."},{"key":"S1463423626101054_ref14","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/18-033"},{"key":"S1463423626101054_ref37","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12645"},{"key":"S1463423626101054_ref30","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14075"},{"key":"S1463423626101054_ref21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-000761"},{"key":"S1463423626101054_ref23","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2013.1113"},{"key":"S1463423626101054_ref38","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2011.38"},{"key":"S1463423626101054_ref2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2020.36.254.23720"},{"key":"S1463423626101054_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000026877"},{"key":"S1463423626101054_ref45","unstructured":"Cover Story | Affordability (2018) Adherence and prior authorization: continuing challenges to optimize outcomes - American College of Cardiology [WWW Document]. Available at https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2018\/04\/17\/12\/42\/cover-story-affordability-adherence-and-prior-authorization-continuing-challenges-to-optimize-outcomes (accessed 25 September 2024)."},{"key":"S1463423626101054_ref6","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-01304-2"},{"key":"S1463423626101054_ref5","doi-asserted-by":"publisher","DOI":"10.1331\/JAPhA.2012.11088"},{"key":"S1463423626101054_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.12.010"},{"key":"S1463423626101054_ref28","doi-asserted-by":"publisher","DOI":"10.1177\/1090198112463021"},{"key":"S1463423626101054_ref47","doi-asserted-by":"publisher","DOI":"10.26099\/c4z8-pf65"},{"key":"S1463423626101054_ref53","unstructured":"Inflation Reduction Act and Medicare | CMS (n.d.) [WWW Document]. Available at https:\/\/www.cms.gov\/inflation-reduction-act-and-medicare (accessed 25 September 2024)."},{"key":"S1463423626101054_ref41","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.053216"},{"key":"S1463423626101054_ref18","unstructured":"NHIS - About the National Health Interview Survey [WWW Document] (2023) Available at https:\/\/www.cdc.gov\/nchs\/nhis\/about_nhis.htm (accessed 25 September 2024)."},{"key":"S1463423626101054_ref13","unstructured":"Klein, D (2020) Medication non-adherence: a common and costly problem - PAN Foundation [WWW Document]. Available at https:\/\/www.panfoundation.org\/medication-non-adherence\/ (accessed 25 September 2024)."},{"key":"S1463423626101054_ref43","unstructured":"Shrank, WH , DeParle, N-A , Gottlieb, S , Jain, SH , Orszag, P , Powers, BW and Wilensky, GR (2021) Health costs and financing: challenges and strategies for a new administration | Health Affairs [WWW Document]. Available at https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2020.01560?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub (accessed 25 September 2024)."},{"key":"S1463423626101054_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2021.02.009"},{"key":"S1463423626101054_ref22","unstructured":"Phillion, M (2022) The Impact of Cost on Medication Adherence [WWW Document]. Patient Safety & Quality Healthcare. Available at https:\/\/www.psqh.com\/analysis\/the-impact-of-cost-on-medication-adherence\/ (accessed 25 September 2024)."},{"key":"S1463423626101054_ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0440-0"},{"key":"S1463423626101054_ref32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-051480"},{"key":"S1463423626101054_ref34","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-023-05640-7"},{"key":"S1463423626101054_ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.06.998"},{"key":"S1463423626101054_ref36","doi-asserted-by":"publisher","DOI":"10.5888\/pcd17.190440"},{"key":"S1463423626101054_ref35","first-page":"1","article-title":"Geographic variation in health insurance coverage: United States, 2021","author":"Terlizzi","year":"2022)","journal-title":"National Health Statistics Reports"},{"key":"S1463423626101054_ref19","doi-asserted-by":"publisher","DOI":"10.5993\/AJHB.44.2.10"},{"key":"S1463423626101054_ref1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.904003"},{"key":"S1463423626101054_ref48","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00481"},{"key":"S1463423626101054_ref39","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14083-y"},{"key":"S1463423626101054_ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-015-0484-5"},{"key":"S1463423626101054_ref20","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2017.0036"},{"key":"S1463423626101054_ref29","doi-asserted-by":"publisher","DOI":"10.3390\/metabo13101087"},{"key":"S1463423626101054_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2007.03.001"}],"container-title":["Primary Health Care Research &amp; Development"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1463423626101054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:11:58Z","timestamp":1774599118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1463423626101054\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":50,"alternative-id":["S1463423626101054"],"URL":"https:\/\/doi.org\/10.1017\/s1463423626101054","relation":{},"ISSN":["1463-4236","1477-1128"],"issn-type":[{"value":"1463-4236","type":"print"},{"value":"1477-1128","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e42"}}