{"doi":"10.1371/journal.pone.0329031","title":"Longitudinal progression of cost-related medication non-adherence among Medicare patients with diabetes at high risk of hospitalization: The role of dual eligibility","abstract":"OBJECTIVE: Little is known about the longitudinal progression of cost-related medication non-adherence (CRN) among the high-need, high-cost diabetes population. We aim to document the longitudinal aspect of CRN among Medicare diabetes patients at high risk of hospitalization and the role of Medicare-Medicaid dual eligibility in CRN. RESEARCH DESIGN AND METHODS: 617 Medicare diabetes patients at high risk of hospitalization were followed up at 3-month intervals for a total of 16 surveys. Patients' socio-demographic and health characteristics by dual eligibility were compared using Chi-square tests. The progression of CRN was documented using a Kaplan-Meier Survival Curve. A Cox Survival Regression analysis and a Generalized Estimating Equation (GEE) analysis were conducted to evaluate the adjusted hazard ratio (HR) and population-averaged effect of dual eligibility on CRN, controlling for socio-demographic and health characteristics. RESULTS: 303 patients (49.1%) reported dual eligibility, among whom 151 (49.8%) reported CRN; they were more likely to be under 65 (p < 0.01), had lower income (p < 0.01), were less likely to report cardiovascular disease (p = 0.05), and were less likely to report CRN (p < 0.01) compared to those who did not report dual eligibility. Those with dual eligibility had a lower hazard ratio (HR = 0.67, p < 0.01) and lower likelihood of reporting CRN (coefficient = -0.40, p < 0.01), and those with depression had higher hazard ratio (HR = 1.31, p = 0.03) and higher likelihood of reporting CRN (coefficient = 0.32, p < 0.01) in the Cox model and GEE, respectively. CONCLUSIONS: While insurance coverage enables patients to overcome their major deficiency in income, many patients fall through the cracks as their disease progresses. Depression is a major risk factor for CRN. Health policy addressing CRN needs to be implemented in tandem with clinical intervention, targeting those at the increasing risk of CRN.","journal":"PLoS ONE","year":2025,"id":572333,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9226,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":504292,"name":"David Meltzer","orcid":"0000-0002-6728-8729","position":1,"is_corresponding":false},{"id":710438,"name":"James Zhang","orcid":"0000-0002-6251-0474","position":0,"is_corresponding":true}],"reference_count":2,"raw_metadata":null,"created_at":"2026-07-19T02:57:23.653298Z","pmid":"40811521","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}