For patients, especially those living with chronic conditions, nonadherence to prescription medicines due to cost is a common problem. By not filling prescriptions, skipping doses, delaying refills, or splitting pills, patients risk compromising the therapeutic benefit of their treatments. To understand the extent of this problem, Jamie Daw, assistant professor of Health Policy and Management at Columbia University Mailman School of Public Health and colleagues at the University of British Columbia, studied survey data from 11 high-income countries. They found that the largest disparities for non-adherence occurred among younger women in the U.S. The study results are published in the August issue of the journal Health Affairs.

The authors compared cost-related nonadherence among younger (ages 18-64) and older men and women (ages 65 or more) in eleven high-income countries including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. They found that the largest disparities for non-adherence occurred among U.S. women compared with men — 54 percent higher — compared to Canada at 33 percent and Australia at 17 percent higher.

Their analysis also showed that in the U.S., one in four younger women reported cost-related nonadherence compared with one in seven younger men, with no significant female-differences among older adults in any of the eleven countries.

«Prescription drug coverage systems —like those in the U.S. and Canada—that rely on employment-based insurance or require high patient contributions may disproportionally affect women, who are less likely to have full-time employment and more likely to be lower income. The disparities we found in access to medicines may produce health disparities between men and women that should be further explored,» said Daw.


Co-author is Michael R. Law, the Canada Research Chair in Access to Medicines and director of the Centre for Health Services and Policy Research, School of Population and Public Health, at the University of British Columbia.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit

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