Study: Minorities with glaucoma facing cost barriers to medication

Investigators have found that racial and ethnic minorities with glaucoma are facing higher cost-related barriers to medication, which remained after controlling for socioeconomic factors.

The cross-sectional study of 3826 patients with glaucoma found significantly higher odds of self-reported difficulty affording medication were observed among non-Hispanic African American and Hispanic individuals compared with non-Hispanic White individuals.¹

The data comes as the world is set to mark World Glaucoma Week March 6-12.

“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 Sally L. Baxter, MD, MSc, Shiley Eye Institute, University of California, San Diego, an author of the study.

The goal of the study was to determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of patients with glaucoma.

The 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 to 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 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.

According to the study, 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.

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.

The study also found that, 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,” the investigators concluded.

Conclusion

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.

World Glaucoma Week

World Glaucoma Week is a global initiative of the World Glaucoma Association (WGA) in order to raise awareness on glaucoma.

“World Glaucoma Week is a unique initiative that puts a spotlight on glaucoma as the leading cause of preventable irreversible blindness worldwide,” Neru Gupta, MD, PhD, MBA, president of World Glaucoma Association and a member of the Ophthalmology Times® Editorial Advisory Board, said in a statement on the WGA website. “The prompt diagnosis and treatment of glaucoma can prevent needless vision impairment, however, so many are unaware they have the disease or may not have access to much-needed care.”

Gupta also noted that as the numbers are expected to increase exponentially, it is a growing public health concern that needs more attention and effective eye health systems.

“The active coming together of the international community with colleagues and key stakeholders through events to stimulate awareness and dialogue is a show of our shared commitment to improving glaucoma care for patients around the world,” she concluded.

Reference

1 Arash Delvar, MPH, Bharanidharan Radha Saseendrakumar, MS, Robert N. Weinreb, MD, et al; 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; JAMA Ophthalmol. Published online March 3, 2022. doi:10.1001/jamaophthalmol.2022.0055