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Background  The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities.    Methods  The data were collected in a cross-sectional study (“ABUEL, Elder abuse: A multinational prevalence survey”) in 2009. Randomly selected people aged 60–84 years ( n  = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2 %. Ethical permission was received in each country.    Results  The results indicate that 3.6 % ( n  = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7 %,  n  = 99) and Portugal (4.3 %,  n  = 28). Other countries reported lower percentages of refraining from buying medications (Germany – 2.0 %, Italy – 1.6 %, Sweden – 1.0 %, Greece – 0.6 %, Spain – 0.3 %). Females refrained more often from buying medications than males (2.6 % vs. 4.4 %,  p  < 0.0001). The prevalence of this refraining tended to increase with economic hardship.    Discussion  These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study.    Conclusions  Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.

The prevalence of self-reported underuse of medications due to cost for the elderly: results from seven European urban communities