Poor people with chronic illness have greater difficulty managing their disease than do their better-off counterparts, and a new study confirms this reality for patients with cystic fibrosis.
Dr. Kimberly Dickinson
and anxiety symptoms, according to a new cross-sectional study. The data were drawn from the Cystic Fibrosis Foundation’s Success with Therapies Research Consortium.
“Assessing the special challenges that individuals with lower SES face, including financial barriers, is essential to understand how we can address the unique combinations of adherence barriers. In other chronic disorders, financial barriers or lower socioeconomic status is associated with nonadherence, but this relationship has not been well established in cystic fibrosis,” said Kimberly Dickinson, MD, MPH, of Johns Hopkins University, Baltimore, during her presentation of the results at the virtual North American Cystic Fibrosis Conference.
Dr. Robert J. Giusti
“I’ve always thought that my patients in the poorer population were doing worse, and I think this demonstrates that that’s true,” said Robert Giusti, MD, in an interview. Dr. Giusti is a clinical professor of pediatrics at the New York University and director of the Pediatric Cystic Fibrosis Center in New York. He was not involved in the study.
“These are very pertinent issues, especially if you think about the pandemic, and some of the issues related to mental health. It just highlights the importance of socioeconomic status and screening for some of the known risk factors so that we can develop interventions or programs to provide equitable care to all of our cystic fibrosis patients,” said Ryan Perkins, MD, who moderated the session where the study was presented. He is a pediatric and adult pulmonary fellow at Boston Children’s Hospital and Brigham and Women’s Hospital, also in Boston.
The researchers looked retrospectively at 1 year’s worth of pharmacy refill receipts and number of times prescriptions were refilled versus the number of times prescribed, then calculated medicinal possession ratios. This was cross-referenced with annual household income and insurance status of patients with CF at 12 pediatric and 9 adult CF care centers, for a total of 376 patients (128 pediatric and 248 adult).
In this population, 32% of participants had public or no insurance, 68% had private or military insurance. The public/no insurance group was more likely than the private/military insurance group to report having trouble paying for treatments, food, or critical expenses related to CF care (23.3% vs. 12.1%, respectively); feeling symptoms on most days of depression (42.5% vs. 31.3%) or anxiety (40.0% vs. 28.5%); and experiencing conflict or stress with loved ones over treatments (30.0% vs. 20.3%) (P < .05 for all).
In all, 35% had a household income less than $40,000 per year, 33% between $44,000 and $100,000, and 32% higher than $100,000. The low-income group had a lower composite medication possession ratio (0.41) than the middle- (0.44) or high-income (0.52) groups, were more likely to have trouble paying for treatments, food, or treatment-related expenses (25%, 18%, 4%, respectively); were more likely most days to report symptoms of depression (43%, 34%, 26%) or anxiety (40%, 32%, 24%), and to have concerns about whether treatments were effective (42%, 27%, 29%). They were more likely to not be able to maintain a daily schedule or routine for treatments (28%, 22%, 14%).
The study showed that adherence barriers and suboptimal adherence are issues that cross all socioeconomic categories, though they were more problematic in the lowest bracket. Greater anxiety and depression among lower income individuals and those with private or no insurance was a key finding, according to Dr. Dickinson. “It highlights the importance of screening for mental health comorbidities that may impact non-adherence,” she said.
The study received funding from the Cystic Fibrosis Foundation. Dr. Dickinson, Dr. Giusti, and Dr. Perkins have no relevant financial disclosures.