Effect of racial differences on ability to afford prescription medications

被引:14
作者
Cobaugh, Daniel J. [1 ]
Angner, Erik [2 ,3 ]
Kiefe, Catarina I. [4 ,5 ]
Ray, Midge N. [6 ,7 ]
LaCivita, Cynthia L. [1 ]
Weissman, Norman W. [6 ]
Saag, Kenneth G. [7 ]
Allison, Jeroan J. [7 ]
机构
[1] Amer Soc Hlth Syst Pharmacists Res & Educ Fdn, Bethesda, MD 20814 USA
[2] Univ Alabama, Dept Philosophy, Birmingham, AL USA
[3] Univ Alabama, Dept Finance, Birmingham, AL USA
[4] UAB, Sch Med, Div Prevent Med, Birmingham, AL USA
[5] UAB, Ctr Outcomes & Effectiveness Res & Educ, Birmingham, AL USA
[6] UAB, Sch Hlth Profess, Dept Hlth Serv Adm, Birmingham, AL USA
[7] UAB, Ctr Educ & Res Therapeut Musculoskeletal Dis, Birmingham, AL USA
基金
美国医疗保健研究与质量局;
关键词
Data collection; Economics; Ethnic groups; Geriatrics; Prescriptions; Sociology;
D O I
10.2146/ajhp080062
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose. The association of race with not filling prescription medications because of cost for African-American and white patients 65 years or older was examined. Methods. African-American and white patients age 65 years or older were recruited from the practices of 48 Alabama primary care physicians participating in the Alabama Nonsteroidal Antiinflammatory Drug Patient Safety Study. All eligible patients were asked questions related to their ability to pay for prescription medications, comorbidities, insurance status, and socioeconomic status. Baseline and follow-up telephone surveys were completed between August 2005 and April 2006. Mediation analysis was conducted to determine whether patients' perceived income inadequacy mediated the association between race and not filling medications using staged logistic regression models and adjusting for age, comorbidities, and traditional markers of socioeconomic position (income, education, and insurance status). Results. Of 399 participants, 32% were African-American, 74% were women, and 53% had an annual household income of <$15,000. Patients not filling prescription medications were more likely to be African-American (50% versus 25%) and to report inadequate income to meet basic needs (61% versus 17%) (p < 0.001 for both comparisons). After adjusting for all covariates except the mediator, the odds ratio (OR) for African Americans not filling a prescription medication was 2.3 when compared with white patients. Adding the mediator (perceived income inadequacy) to the model reduced the OR to 1.4. Conclusion. African Americans reported markedly greater difficulty in affording prescription medications than did white patients, even after accounting for income, education, health insurance status, and comorbidities. The inability of African Americans to afford prescription medications may be better predicted by perceived income inadequacy than more traditional measures of socioeconomic status.
引用
收藏
页码:2137 / 2143
页数:7
相关论文
共 46 条
[11]   Physician follow-up and provider continuity are associated with long-term medication adherence - A study of the dynamics of statin use [J].
Brookhart, M. Alan ;
Patrick, Amanda R. ;
Schneeweiss, Sebastian ;
Avorn, Jerry ;
Dormuth, Colin ;
Shrank, William ;
van Wijk, Boris L. G. ;
Cadarette, Suzanne M. ;
Canning, Claire F. ;
Solomon, Daniel H. .
ARCHIVES OF INTERNAL MEDICINE, 2007, 167 (08) :847-852
[12]  
Crystal S, 2000, J GERONTOL B-PSYCHOL, V55, pS51
[13]  
Dominick KL, 2004, ETHNIC DIS, V14, P558
[14]  
Efron B., 1993, INTRO BOOTSTRAP MONO, DOI DOI 10.1201/9780429246593
[15]   Factors associated with medication adherence in African American and white patients with bipolar disorder [J].
Fleck, DE ;
Keck, PE ;
Corey, KB ;
Strakowski, SM .
JOURNAL OF CLINICAL PSYCHIATRY, 2005, 66 (05) :646-652
[16]   Medication adherence in heart failure [J].
Hauptman, Paul J. .
HEART FAILURE REVIEWS, 2008, 13 (01) :99-106
[17]   Clinician identification of chronically ill patients who have problems paying for prescription medications [J].
Heisler, M ;
Wagner, TH ;
Piette, JD .
AMERICAN JOURNAL OF MEDICINE, 2004, 116 (11) :753-758
[18]   Racial and ethnic disparities in the emergency department: A public health perspective [J].
Heron, Sheryl L. ;
Stettner, Edward ;
Haley, Leon L., Jr. .
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA, 2006, 24 (04) :905-+
[19]   Projecting future drug expenditures - 2006 [J].
Hoffman, JM ;
Shah, ND ;
Vermeulen, LC ;
Schumock, GT ;
Grim, P ;
Hunkler, RJ ;
Hontz, KM .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2006, 63 (02) :123-138
[20]   The emergency department for routine healthcare: Race/ethnicity, socioeconomic status, and perceptual factors [J].
Hong, Rick ;
Baumann, Brigitte M. ;
Boudreaux, Edwin D. .
JOURNAL OF EMERGENCY MEDICINE, 2007, 32 (02) :149-158