Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla.
UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla.
JAMA Ophthalmol. 2022 Apr 1;140(4):354-361. doi: 10.1001/jamaophthalmol.2022.0055.
Ability to afford medication is a major determinate of medication adherence among patients.
To determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of patients with glaucoma.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included patients with glaucoma enrolled in the National Institutes of Health All of Us Research Program, a nationwide longitudinal cohort of US adults, with more than 300 000 currently enrolled. Individuals with a diagnosis of glaucoma based on electronic health record diagnosis codes who participated in the Health Care Access and Utilization survey and had complete data on all covariates were studied. Data were collected from June 2016 to March 2021, and data were analyzed from August to November 2021.
Race and ethnicity defined as non-Hispanic African American, non-Hispanic Asian, Hispanic, and non-Hispanic White.
Logistic regression was used to evaluate the association between reported cost-related barriers to medication adherence (could not afford prescription medication, skipped medication doses to save money, took less medication to save money, delayed filling a prescription to save money, asked for lower-cost medication to save money, bought prescriptions from another country to save money, and used alternative therapies to save money) and race and ethnicity, adjusting multivariable models by age, gender, health insurance status, education, and income. Odds ratios of these barriers were obtained by race and ethnicity, with non-Hispanic White race as the reference group.
Of 3826 included patients with glaucoma, 481 (12.6%) were African American, 119 (3.1%) were non-Hispanic Asian, 351 (9.2%) were Hispanic, and 2875 (75.1%) were non-Hispanic White. The median (IQR) age was 69 (60-75) years, and 2307 (60.3%) were female. After adjusting for confounders, non-Hispanic African American individuals (odds ratio, 1.82; 95% CI, 1.34-2.44) and Hispanic individuals (odds ratio, 1.77; 95% CI, 1.25-2.49) were more likely than non-Hispanic White individuals to report not being able to afford medications. Further, despite having the lowest rate of endorsing difficulty affording medications, non-Hispanic White individuals were equally likely to ask for lower-cost medication from their clinicians as individuals of racial and ethnic minority groups.
In this study, there was significantly higher odds of self-reported difficulty affording medications among non-Hispanic African American and Hispanic individuals compared with non-Hispanic White individuals. Clinicians should be proactive and initiate discussions about costs in an effort to promote medication adherence and health equity among patients.
药物可负担性是影响患者药物依从性的主要决定因素。
在全国范围内的青光眼患者队列中，按种族和民族确定与药物依从性相关的费用障碍。
设计、设置和参与者：这项横断面研究纳入了参加美国国立卫生研究院全美国研究计划的青光眼患者，这是一个全国性的美国成年人纵向队列，目前有超过 30 万人参与。根据电子健康记录诊断代码诊断为青光眼的个体，如果参加了医疗保健获取和利用调查且所有协变量数据完整，则对其进行研究。数据于 2016 年 6 月至 2021 年 3 月收集，2021 年 8 月至 11 月进行数据分析。
种族和民族定义为非西班牙裔非裔美国人、非西班牙裔亚裔、西班牙裔和非西班牙裔白人。
采用 logistic 回归评估报告的与药物依从性相关的费用障碍（买不起处方药、为省钱漏服药物剂量、为省钱少服药物、为省钱延迟开处方、要求开更便宜的药物、从其他国家购买处方药物、使用替代疗法省钱）与种族和民族之间的关联，通过年龄、性别、保险状况、教育和收入调整多变量模型。通过种族和民族获得这些障碍的优势比，以非西班牙裔白人为参考组。
在 3826 名纳入的青光眼患者中，481 名（12.6%）为非裔美国人，119 名（3.1%）为非西班牙裔亚裔，351 名（9.2%）为西班牙裔，2875 名（75.1%）为非西班牙裔白人。中位（IQR）年龄为 69（60-75）岁，2307 名（60.3%）为女性。在调整混杂因素后，非西班牙裔非裔美国人（比值比，1.82；95%CI，1.34-2.44）和西班牙裔（比值比，1.77；95%CI，1.25-2.49）个体比非西班牙裔白人个体更有可能报告无法负担药物费用。此外，尽管非西班牙裔白人个体报告难以负担药物的比例最低，但他们同样有可能向临床医生要求开更便宜的药物，与种族和民族少数群体的个体一样。
在这项研究中，与非西班牙裔白人个体相比，非西班牙裔非裔美国人和西班牙裔个体自我报告难以负担药物的可能性明显更高。临床医生应积极主动地讨论费用问题，以促进患者的药物依从性和医疗公平。
