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Reduced medication access: a marker for vulnerability in US stroke survivors
Quantitative Health Sciences Publications and Presentations
  • Deborah A. Levine, Ohio State University
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • George Howard, University of Alabama
  • Virginia J. Howard, University of Alabama
  • O. Dale Williams, University of Alabama
  • Jeroan J. Allison, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
African Americans; Aged; European Continental Ancestry Group; Female; Health Services Accessibility; Humans; Male; Middle Aged; Recurrence; Socioeconomic Factors; Stroke; United States

BACKGROUND AND PURPOSE: Medication access is crucial to secondary stroke prevention. We assessed medication access and associated barriers to care across region and time in a national sample of US stroke survivors.

METHODS: Among all 5840 black or white stroke survivors aged > or =45 years responding to the National Health Interview Survey years 1997 to 2004, we examined inability to afford medications within the last 12 months across region (Northeast, Midwest, West, South) and time. With logistic regression, we adjusted associations between medication inaffordability and region and time for age, sex, race, neurological disability, comorbidity, health status, insurance, income and out-of-pocket medical expenses.

RESULTS: In 2004, approximately 76,000 US stroke survivors were unable to afford medications. Lower medication affordability was reported among stroke survivors who were <65 years old, black, female, had high comorbidity or low health status. Compared with stroke survivors able to afford medications, those unable more frequently reported lack of transportation (15% versus 3%; P<0.001), no health insurance (16% versus 3%; P<0.001), no usual place of care (6% versus 2%; P=0.001), income <$20,000 (66% versus 40%; P<0.001) and out-of-pocket medical expenses > or =$2000 (35% versus 25%; P<0.001). From 1997 to 2004, inability to afford medications increased significantly from 8.1% to 12.7% (P(trend)=0.01) overall and increased in all US regions except the Northeast.

CONCLUSIONS: We identified a vulnerable stroke survivor population with reduced medication access and increased barriers to medical care. Membership in this population has grown substantially from 1997 to 2004, potentially leading to increased recurrent stroke incidence.

DOI of Published Version
Stroke. 2007 May;38(5):1557-64. Epub 2007 Mar 29. Link to article on publisher's site
PubMed ID
Related Resources
Link to Article in PubMed
Citation Information
Deborah A. Levine, Catarina I. Kiefe, George Howard, Virginia J. Howard, et al.. "Reduced medication access: a marker for vulnerability in US stroke survivors" Vol. 38 Iss. 5 (2007) ISSN: 0039-2499 (Linking)
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