New York—As pharmacists well know, medications don’t work if patients don’t fill their prescriptions. What might surprise them, however, is that younger women in the United States have especially high rates of nonadherence, according to a new study.

A report in Health Affairs points out that therapeutic benefits of drugs are compromised by not filling prescriptions, skipping doses, delaying refills, or splitting pills. Yet it also concedes that nonadherence to treatment regimens due to cost is a common problem.

To gauge the reach of the problem, researchers from the Columbia University Mailman School of Public Health and at the University of British Columbia reviewed survey data from 11 high-income countries. Results indicate that the largest disparities for nonadherence occurred among younger women in the United States.

The study used data from the Commonwealth Fund International Health Policy Survey to compare cost-related nonadherence among younger (ages 18 to 64 years) and older men and women (ages 65 years or older) in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Disparities for nonadherence among U.S. women compared with men—54% higher—was much higher than other high-income countries, including 33% in Canada and 17% in Australia.

The analysis also reveals that, in the United States, one in four younger women reported cost-related nonadherence versus one in seven younger men, with no significant differences among female older adults in any of the 11 countries.

“Prescription drug coverage systems—like those in the U.S. and Canada—that rely on employment-based insurance or require high patient contributions may disproportionally affect women, who are less likely to have full-time employment and more likely to be lower income,” said lead author Jamie R. Daw, PhD, of Columbia. “The disparities we found in access to medicines may produce health disparities between men and women that should be further explored.”

The study also found smaller but significant female-male differences among younger women in Australia and Canada, although the authors emphasize, “We did not find significant female-male differences among older adults in adjusted analyses in any country.”

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