Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

Abstract

IMPORTANCE Ability to afford medication is a major determinate of medication adherence among patients.OBJECTIVE To determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of patients with glaucoma. DESIGN, SETTING, AND PARTICIPANTSThis 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.EXPOSURES Race and ethnicity defined as non-Hispanic African American, non-Hispanic Asian, Hispanic, and non-Hispanic White.MAIN OUTCOMES AND MEASURES 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. RESULTSOf 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.CONCLUSIONS AND RELEVANCE 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.

Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort

“…17 African American and Hispanic glaucoma patients have been shown to have more cost-related barriers to obtaining their medications, which may confer worse medication adherence and glaucoma outcomes. 18 In addition, anatomical differences by race, such as larger optic disks with less reserve axons and thinner corneas leading to an underestimation of intraocular pressure on applanation among those of African descent, are thought to play a role. 19,20 Glaucoma patients in this cohort differed on several key measures of socioeconomic status, including education, employment, and home ownership.…”

Nation-Wide Analysis of Glaucoma Medication Prescription in Fiscal Year of 2019 in Japan

“…Age, sex, and interaction between age and sex were associated with the prescription dose ( Table 3 ). In the USA, of 3826 patients with glaucoma selected from the nationwide longitudinal cohort, the median age group was 60–75 years, and 60.3% were women [ 14 ]. In the USA from 2004 to 2009, the proportion of the population with ocular hypotensive treatment was 11.5% while was 1.2% in 50–64 year, thus the proportion suddenly increased in the 65–79 years group and older [ 13 ].…”

Unpacking the Barriers to Medication Adherence May Move Us Closer to Eye Health Equity

“…Their essential findings were as follows: (1) individuals who self-reported African American race and Hispanic ethnicity were more likely to report prescribed medications to be unaffordable compared with individuals of other races and ethnicities and (2) individuals who self-reported non-Hispanic White race were as likely as individuals of other races and ethnicities to request lower-cost medications. The authors concluded that among individuals of non-Hispanic African American race and Hispanic ethnicity, there were higher odds of self-reported difficulty affording medications compared with individuals of other races and ethnicities . Although it is not the purpose of this commentary to critique the article, there are a few points to underscore before providing a context for considering the salient points raised by the authors.…”

“…In their article entitled “Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program,” Delavar et al analyzed responses regarding medication adherence in 3826 people with a diagnosis of glaucoma of the 350 000 individuals who participated in the National Institutes of Health All of Us database. These responses were associated with self-reported demographic characteristics.…”