A population-based study on cost-related underuse of medicines by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil

The aim of this study was to estimate the prevalence of cost-related underuse of medicines and associated factors in a representative sample of 1,134 elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of cost-related underuse was 12.9%. After adjustments in the multivariate model, cost-related underuse was higher in individuals with income less than twice the minimum wage (PR = 0.57; 95% CI: 0.34-0.97), without health plan coverage (PR = 0.68; CI95%: 0.46-0.99), with low frequencies of physician-patient dialogue concerning health/treatment (rarely/never, PR = 1.79; 95% CI: 1.10-2.90), with fair to poor self-rated health (PR = 1.66; 95% CI: 0.95-2.90 and PR = 2.49; 95% CI: 1.38-4.48, respectively), and with multiple comorbidities (one, PR = 2.51; 95% CI: 0.99-6.35; two, PR = 3.51; 95% CI: 1.40-8.72 and three or more, PR = 4.52; 95% CI: 1.79-11.41). Our results suggest adherence problems within this population due to a communication gap between seniors and physicians on treatment-related aspects and to the lack of health plan coverage. Especially worrisome is the high risk of cost-related underuse among elderly with poor health.