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Published online November 13, 2007
Diabetes Care 31:261-266, 2008
DOI: 10.2337/dc07-1341
© 2008 by the American Diabetes Association
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Epidemiology/Health Services Research
Original Research

Race/Ethnicity and Economic Differences in Cost-Related Medication Underuse Among Insured Adults With Diabetes

The Translating Research Into Action for Diabetes Study

Chien-Wen Tseng, MD, MPH1,2, Edward F. Tierney, MPH3, Robert B. Gerzoff, MS3, R. Adams Dudley, MD, MBA4, Beth Waitzfelder, PHD1, Ronald T. Ackermann, MD, MPH5, Andrew J. Karter, PHD6, John Piette, PHD7, Jesse C. Crosson, PHD8,9, Quyen Ngo-Metzger, MD, MPH10, Richard Chung, MD11 and Carol M. Mangione, MD, MSPH12

1 Pacific Health Research Institute, Honolulu, Hawaii
2 Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
3 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
4 Department of Medicine and Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
5 Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
6 Division of Research, Kaiser Permanente Medical Care Program, Northern California, Oakland, California
7 Department of Veterans Affairs Center for Practice Management and Outcomes Research and Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
8 Department of Family Medicine, University of Medicine and Dentistry New Jersey, New Jersey Medical School, Newark, New Jersey
9 Research Division, Department of Family Medicine, Robert Wood Johnson Medical School, Somerset, New Jersey
10 Division of General Medicine and Primary Care and the Center for Health Policy Research, University of California Irvine College of Medicine, Irvine, California
11 Hawaii Medical Service Association, Honolulu, Hawaii
12 David Geffen School of Medicine and School of Public Health, University of California Los Angeles, Los Angeles, California

Address correspondence and reprint requests to Chien-Wen Tseng, c/o Pacific Health Research Institute, 846 S Hotel St., #303, Honolulu, HI 96813. E-mail: cwtseng{at}hawaii.edu

OBJECTIVE—To examine racial/ethnic and economic variation in cost-related medication underuse among insured adults with diabetes.

RESEARCH DESIGN AND METHODS—We surveyed 5,086 participants from the multicenter Translating Research Into Action for Diabetes Study. Respondents reported whether they used less medication because of cost in the past 12 months. We examined unadjusted and adjusted rates of cost-related medication underuse, using hierarchical regression, to determine whether race/ethnicity differences still existed after accounting for economic, health, and other demographic variables.

RESULTS—Participants were 48% white, 14% African American, 14% Latino, 15% Asian/Pacific Islander, and 8% other. Overall, 14% reported cost-related medication underuse. Unadjusted rates were highest for Latinos (23%) and African Americans (17%) compared with whites (13%), Asian/Pacific Islanders (11%), and others (15%). In multivariate analyses, race/ethnicity significantly predicted cost-related medication underuse (P = 0.048). However, adjusted rates were only slightly higher for Latinos (14%) than whites (10%) (P = 0.026) and were not significantly different for African Americans (11%), Asian/Pacific Islanders (7%), and others (11%). Income and out-of-pocket drug costs showed the greatest differences in adjusted rates of cost-related medication underuse (15 vs. 5% for participants with income ≤$25,000 vs. >$50,000 and 24 vs. 7% for participants with out-of-pocket costs >$150 per month vs. ≤$50 per month.

CONCLUSIONS—One in seven participants reported cost-related medication underuse. Rates were highest among African Americans and Latinos but were related to lower incomes and higher out-of-pocket drug costs in these groups. Interventions to decrease racial/ethnic disparities in cost-related medication underuse should focus on decreasing financial barriers to medications.

Abbreviations: TRIAD, Translating Research Into Action for Diabetes


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