Financial Toxicity and Cost-Related Nonadherence in Adults with Type 1 Diabetes.

Abstract

With the rising costs of insulin and overwhelming financial burden of managing diabetes, there is heightened concern for financial toxicity and cost related nonadherence (CRN), particularly in people with type 1 diabetes (T1D). To describe the prevalence of financial toxicity and CRN in adults with T1D, examine associations with social determinants of health (SDOH), and explore the impact of lifespan development. This is a secondary analysis of baseline data from a larger randomized controlled trial of adults with diabetes and unmet social needs. A subsample of 130 participants with T1D. The primary outcome was CRN, defined as reporting using less insulin, medication, or supplies, or delaying/avoiding filling a prescription or seeing a healthcare provider because of costs. Participants had a mean age of 41.1 ± 15.5 (range 19-74), 64.6% were female, 78.5% identified as non-Hispanic White, and 54.6% reported ≥ $60,000 in annual income. In total, 51.5% were employed and 56.9% had private insurance; 32.3% endorsed at least one CRN behavior and 78.5% reported elevated financial toxicity. The only significant difference in CRN was by age, where 44.4% of participants ≤ 30 years reported CRN compared to only 25.9% of participants > 30 years (p < 0.05). A logistic regression analysis to predict CRN found that two factors were statistically significant predictors: elevated financial toxicity (OR 7.29, 95% CI 1.96, 27.16) and having private insurance (OR 2.88, 95% CI 1.17, 7.08). Age was nearly significant (p = 0.057), with participants ≤ 30 years 2.25 times more likely to report CRN compared to older age groups. Adults living with T1D experience high levels of financial toxicity and CRN. Young adults appear to be at higher risk for CRN, a pattern that does not appear to be explained by conventional SDOH-related factors often attributed to CRN during other life stages.