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Race/Ethnicity and Nonadherence to Prescription Medications Among Seniors: Results of a National Study

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Abstract

BACKGROUND

Nonadherence to prescription drugs results in poorer control of chronic health conditions. Because of significant racial/ethnic disparities in the control of many chronic diseases, differences in the rates of and reasons for medication nonadherence should be studied.

OBJECTIVES

1) To determine whether rates of and reasons for medication nonadherence vary by race/ethnicity among seniors; and 2) to evaluate whether any association between race/ethnicity and nonadherence is moderated by prescription coverage and income.

DESIGN/SETTING

Cross-sectional national survey, 2003.

PATIENTS

Medicare beneficiaries ≥65 years of age, who reported their race/ethnicity as white, black, or Hispanic, and who reported taking at least 1 medication (n = 14,829).

MAIN OUTCOME MEASURES

Self-reported nonadherence (caused by cost, self-assessed need, or experiences/side effects) during the last 12 months.

RESULTS

Blacks and Hispanics were more likely than whites to report cost-related nonadherence (35.1%, 36.5%, and 26.7%, respectively, p < .001). There were no racial/ethnic differences in nonadherence caused by experiences or self-assessed need. In analyses controlling for age, gender, number of chronic conditions and medications, education, and presence and type of prescription drug coverage, blacks (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.08–1.78) and Hispanics (1.35; 1.02–1.78) remained more likely to report cost-related nonadherence compared to whites. When income was added to the model, the relationship between cost-related nonadherence and race/ethnicity was no longer statistically significant (p = .12).

CONCLUSIONS

Racial/ethnic disparities in medication nonadherence exist among seniors, and are related to cost concerns, and not to differences in experiences or self-assessed need. Considering the importance of medication adherence in controlling chronic diseases, affordability of prescriptions should be explicitly addressed to reduce racial/ethnic disparities.

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Acknowledgements

Preparation and production of this manuscript was supported by a National Research Service Award (T32HP11001-18). The design and conduct of the 2003 survey on which these analyses are based was supported by funding from the Commonwealth Fund and the Henry J. Kaiser Family Foundation (KFF) under the direction of Dr. Safran at Tufts-New England Medical Center. Dr. Safran and her team gratefully acknowledge the technical expertise and support provided by Lawrence (Spike) Duzor, Dural Suite, Robyn Thomas of the Centers for Medicare and Medicaid Services (CMS), and Kelly Merriman of ResDAC, without whom the conduct of the survey would not have been possible; and Tricia Neuman and Michelle Kitchman (KFF) and Cathy Schoen (Commonwealth Fund), whose partnership contributed immeasurably to the richness of the survey content and study design. The contents of this paper are the sole responsibility of the authors and do not necessarily represent the views of the Harvard Medical School, Brigham and Women’s Hospital, Tufts-New England Medical Center, or Tufts Medical School.

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Correspondence to Jennifer S. Haas MD, MSPH.

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Gellad, W.F., Haas, J.S. & Safran, D.G. Race/Ethnicity and Nonadherence to Prescription Medications Among Seniors: Results of a National Study. J GEN INTERN MED 22, 1572–1578 (2007). https://doi.org/10.1007/s11606-007-0385-z

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  • DOI: https://doi.org/10.1007/s11606-007-0385-z

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