Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA.
Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA.
Health Serv Res. 2023 Aug;58 Suppl 2(Suppl 2):175-185. doi: 10.1111/1475-6773.14185. Epub 2023 May 31.
To assess inequities in prescription medication use and subsequent cost-related nonadherence (CRN) and cost-saving strategies by citizenship status in the United States.
DATA SOURCES/STUDY SETTING: National Health Interview Survey (2017-2021).
This cross-sectional study examined noncitizen (n = 8596), naturalized citizen (n = 12,800), and US-born citizen (n = 120,195) adults. We also examined older adults (≥65 years) separately, including noncitizens without Medicare (a group of importance given their immigration-related barriers to health care access). Multiple mediation analysis was used to examine differences in CRN and determine whether economic, health care, and immigration factors explain observed inequities.
Noncitizens (41.9%) were less likely to use prescription medications than naturalized (60.5%) and US-born citizens (68.2%). Among prescription medication users, noncitizens (13.8%) were more likely to report CRN than naturalized (9.5%) and US-born citizens (11.0%). CRN differences between noncitizens and naturalized citizens (OR 1.38, 95% CI 1.21-1.44) and between noncitizens and US-born citizens (OR 1.23, 95% CI 1.07-1.35) were explained by insurance status and food insecurity. Only 4.9% of medication users turned to alternative therapies to lower their drug costs, but there were no substantial differences across citizenship status. More medication users requested lower-cost prescriptions (19.0%); however, noncitizens were less likely to make these requests. Older noncitizens without Medicare, of whom 23.9% requested lower-cost drugs, were an exception. Noncitizens (5.8%), particularly older noncitizens without Medicare (21.8%), were more likely to import their drugs than naturalized (3.5%) and US-born citizens (1.2%).
Noncitizens experience a high burden of cost-related barriers to prescription medications. Efforts to reduce these inequities should focus on dismantling health care and food access barriers, regardless of citizenship status.
评估美国公民身份对处方药使用和随后的与费用相关的不依从（CRN）以及节省费用策略的影响。
数据来源/研究范围：国家健康访谈调查（2017-2021 年）。
本横断面研究调查了非公民（n=8596）、归化公民（n=12800）和美国出生公民（n=120195）成年人。我们还分别研究了老年人（≥65 岁），包括没有医疗保险的非公民（鉴于他们在获得医疗保健方面的移民相关障碍，这是一个重要的群体）。采用多中介分析来检验 CRN 的差异，并确定经济、医疗保健和移民因素是否可以解释观察到的不平等现象。
非公民（41.9%）使用处方药的可能性低于归化公民（60.5%）和美国出生公民（68.2%）。在使用处方药的人群中，非公民（13.8%）比归化公民（9.5%）和美国出生公民（11.0%）更有可能报告 CRN。非公民和归化公民（OR 1.38，95%CI 1.21-1.44）以及非公民和美国出生公民（OR 1.23，95%CI 1.07-1.35）之间的 CRN 差异可以通过保险状况和食品不安全来解释。只有 4.9%的药物使用者采用替代疗法来降低药物成本，但公民身份之间没有实质性差异。更多的药物使用者要求开更便宜的处方（19.0%）；然而，非公民不太可能提出这些要求。没有医疗保险的老年非公民是一个例外，他们中有 23.9%要求开更便宜的药物。非公民（5.8%），特别是没有医疗保险的老年非公民（21.8%），比归化公民（3.5%）和美国出生公民（1.2%）更有可能进口药物。
非公民在获得处方药方面面临着与费用相关的障碍的沉重负担。减少这些不平等现象的努力应该侧重于消除医疗保健和食品获取方面的障碍，而不论公民身份如何。
