Minority Patients With Glaucoma Have Greater Cost-Related Barriers to Medication

Sally L. Baxter, MD, MSc

Racial and ethnic minorities with glaucoma have significantly higher cost-related barriers to medication, which remained after controlling for socioeconomic factors, according to new findings.

Data show significantly greater odds of self-reported difficulty affording medication among non-Hispanic African American and Hispanic individuals with glaucoma, when compared to non-Hispanic White individuals.

“Being a chronic disease that frequently requires access to health care, close follow-up, and sometimes complicated and expensive medical and surgical regimens, glaucoma outcomes are often tied to socioeconomic factors, which are invariably linked with race and ethnicity in the US,” wrote study author Sally L. Baxter, MD, MSc, Shiley Eye Institute, University of California, San Diego.

The cross-sectional study consisted of a nationwide cohort obtained from the National Institutes of Health (NIH) All of Us Research Program, which included 331,380 participants at the time of analysis. Racial categories were self-identified by patients and included African American, Asian, White, multiple, and others.

Based on electronic health record codes, a total of 15,392 individuals were identified in the database. After exclusions, 3826 (70.6%) individuals were included in the final data set. Data were collected in June 2016 - March 2021 and analyzed from August - November 2021.

Investigators studied 7 yes/no questions in the All of Us Health Care Access and Utilization survey, asking participants if there was any time in the past 12 months where they could not afford prescription medication or aimed to save money by skipping medicine or taking less.

Logistic regression generated odds ratios (ORs) and 95% CIs to then describe responses regarding cost-related barriers to medication adherence between races and ethnicities.

Of the patient population (n = 3826), 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, with a median age of 69 years and 2307 (60.3%) were female.

Patients responded to the Access and Utilization survey as follows:

• 359 respondents (9.4%) reported they could not afford medication
• 503 (5.3%) skipped medications
• 227 (5.9%) took less medication
• 317 (8.3%) delayed filling medication
• 730 (19.1%) asked for lower-cost medication
• 140 (3.7%) bought medication from another country
• 198 (5.2%) used alternative therapies to save money

Data show overall, 152 non-Hispanic African American individuals (31.6%), 37 non-Hispanic Asian individuals (31.0%), 113 Hispanic individuals (32.2%), and 777 non-Hispanic White individuals (27.0%) answered yes to ≥1 cost-related medication and adherence survey question.

In multivariable logistic regression models adjusting for age, gender, insurance status, education, and income, non-Hispanic African American individuals (OR, 1.82; 95% CI, 1.34 - 2.44) and Hispanic individuals (OR, 1.77; 95% CI, 1.25 - 2.49) were more likely than non-Hispanic White individuals to report not being able to afford medications.

Additionally, despite the lowest rate of endorsing difficulty affording medications, non-Hispanic White patients reported asking for lower cost medications in the past 12 months at a rate equal to those of other racial and ethnic minority groups.

“Clinicians should take a proactive role in prescribing medications that are most compatible with their patients’ ability to pay in an effort to promote medication adherence and health equity among patients with glaucoma,” concluded the investigators.

The study, “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,” was published in JAMA Ophthalmology.