Sahu Maitreyi, Wagner Tyler D, Thomson Azalea, Beauchamp Meera, Campbell Jonathan D, Crosby Sawyer, DeJarnatt Drew, Lescinsky Haley, Salih Rayan K, Taylor Kayla, Weil Maxwell, Dwyer-Lindgren Laura, Haakenstad Annie, Scott John W, Stergachis Andy, Essien Utibe R, Dieleman Joseph L
Department of Health Metrics Sciences, University of Washington, Seattle.
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
JAMA Health Forum. 2025 Aug 1;6(8):e252329. doi: 10.1001/jamahealthforum.2025.2329.
Achieving equitable access to medicines requires understanding of how pharmaceutical use and spending vary by race and ethnicity across the US.
To quantify variation in prescription drug utilization and spending per capita and per prevalent case by race, ethnicity, health condition, payer, and US state.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, the US Disease Expenditure project was extended to incorporate disaggregation by race and ethnicity for state-level retail prescription drug utilization and spending-in addition to 143 health conditions, 38 age and sex groups, and 4 payers (Medicare, Medicaid, private insurance, and out of pocket)-across the 2019 population in all 50 states and Washington, DC. Data were analyzed from October 2023 to April 2025.
Four mutually exclusive racial and ethnic groups (Asian or Pacific Islander, Black, Hispanic, and White).
Outcomes include prescriptions dispensed and spending for retail pharmaceuticals. Estimates were standardized by population size, population age, and-where data permitted-by disease burden (52 conditions). Das Gupta decomposition was used to estimate the relative contribution of 3 factors (disease prevalence, prescriptions per prevalent case, and spending per prescription) on observed disparities in age-standardized per capita pharmaceutical spending.
In 2019, age-standardized pharmaceutical utilization and spending per person with a given disease was substantially lower than the all-population mean for Black populations, close to the mean for Hispanic populations, and often higher than the mean for Asian or Pacific Islander and White populations. These trends-particularly those for the Black population-were generally consistent across 52 health conditions but varied widely across payers and US states. The decomposition analysis for these 52 conditions showed that differences in per capita pharmaceutical spending across race and ethnicity groups were primarily explained by disease prevalence for Black populations (associated with increased per capita spending) and by utilization rates per prevalent case for Hispanic populations (also associated with increased spending). In contrast, differences in drug price or product type (spending per prescription) contributed less to observed spending disparities.
In this cross-sectional study, racial and ethnic disparities in medication use persisted, most notably the underutilization of medicines relative to disease burden among Black populations. These patterns varied by state, highlighting the need for local- and condition-specific approaches to advancing pharmacoequity in the US.
实现药品的公平可及需要了解美国不同种族和族裔群体在药品使用和支出方面的差异。
按种族、族裔、健康状况、支付方和美国各州，量化处方药人均使用量和人均支出以及每例流行病例的使用量和支出。
设计、背景和参与者：在这项横断面研究中，美国疾病支出项目得到扩展，除了涵盖143种健康状况、38个年龄和性别组以及4种支付方（医疗保险、医疗补助、私人保险和自付费用）外，还纳入了按种族和族裔分类的州级零售处方药使用情况和支出数据 —— 涉及全美50个州和华盛顿特区的2019年人口。数据于2023年10月至2025年4月进行分析。
四个相互排斥的种族和族裔群体（亚裔或太平洋岛民、黑人、西班牙裔和白人）。
结局包括零售药品的配药量和支出。估计值按人口规模、人口年龄以及（在数据允许的情况下）按疾病负担（52种疾病）进行了标准化。使用达斯古普塔分解法来估计疾病患病率、每例流行病例的处方量和每张处方支出这三个因素对年龄标准化人均药品支出中观察到的差异的相对贡献。
2019年，患有特定疾病的人群中，年龄标准化的药品使用量和人均支出显著低于黑人总体人群的平均水平，接近西班牙裔人群的平均水平，且往往高于亚裔或太平洋岛民以及白人总体人群的平均水平。这些趋势 —— 尤其是黑人人群的趋势 —— 在52种健康状况下总体一致，但在不同支付方和美国各州之间差异很大。对这52种疾病的分解分析表明，不同种族和族裔群体之间人均药品支出的差异主要由黑人人群的疾病患病率（与人均支出增加相关）以及西班牙裔人群每例流行病例的使用率（也与支出增加相关）来解释。相比之下，药品价格或产品类型（每张处方的支出）差异对观察到的支出差异贡献较小。
在这项横断面研究中，用药方面的种族和族裔差异依然存在，最明显的是黑人人群相对于疾病负担而言药品利用不足。这些模式因州而异，凸显了在美国推进药物公平性需要因地制宜、因病情而异的方法。
