# Inequality in prevalence of unmedicated hypertension or diabetes among older Filipinos: analysis of nationally representative survey data

## TL;DR

Despite free medications in the Philippines, poorer and less educated older adults are more likely to remain unmedicated for hypertension or diabetes, indicating non-price barriers still exist.

## Contribution

This study is among the few to examine inequalities in medication adherence for hypertension and diabetes in older Filipinos using nationally representative data.

## Key findings

- 30.7% of older Filipinos diagnosed with hypertension or diabetes were unmedicated.
- Wealthier and more educated individuals were more likely to be medicated.
- Non-price barriers like transport and awareness contribute to medication inequality.

## Abstract

Public clinics in the Philippines provide free anti-hypertensive and anti-diabetic medications, removing the price barrier to accessing effective treatments. We aimed to assess whether this is sufficient to eliminate inequality in prevalence of unmedicated hypertension (HTN) or diabetes (DM) among older Filipinos diagnosed with either condition.

We used cross-sectional survey data from a sample representative of the Philippines’ population aged 60+ years in 2018-19. We selected participants who reported being diagnosed with HTN or DM. We estimated the probability of not taking medication for either condition (unmedicated) overall and by wealth index quintile, educational attainment and covariates. We used probit to estimate fully adjusted risk differences (RDs).

We estimated that 30.7% [95% CI: 26.1, 35.5] of older Filipinos diagnosed with HTN or DM were unmedicated. Age-sex adjusted prevalence was higher at lower wealth (poorest: 57.8%; 43.2, 71.5) and education (≤elementary: 34.5%; 29.5, 39.8). Prevalence was also higher for those who were: diagnosed with DM only, male, rural, living alone, not working, not receiving remittances, not senior citizen registered, cognitively impaired and smokers. With full adjustment, the poorest-richest quintile RD was 28.3 percentage points (pp) [13.6, 43.0] and the lowest-highest education RD was 4.2 pp [-6.9, 15.3].

High and unequal risk of being unmedicated for diagnosed HTN or DM, despite free maintenance medications, suggests important non-price barriers related to transport, stockouts, awareness and adherence.

•Few studies examine the cascade of care for both hypertension and diabetes.•We found 31% of older Filipinos diagnosed with either condition were unmedicated.•Poorer and less educated groups were even less likely to be medicated.•This inequality persists despite free provision of maintenance medications.•This points to the importance of non-price barriers.

Few studies examine the cascade of care for both hypertension and diabetes.

We found 31% of older Filipinos diagnosed with either condition were unmedicated.

Poorer and less educated groups were even less likely to be medicated.

This inequality persists despite free provision of maintenance medications.

This points to the importance of non-price barriers.