eAppendix. Question Wording, Sample Adult – 2015-2018 National Health Interview Survey
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Das RK, Gonzales G. Self-reported Behaviors Regarding Medications to Save Money Among Sexual Minority Adults in the US, 2015-2018. JAMA. 2021;326(24):2526–2529. doi:10.1001/jama.2021.20335
Individuals who belong to sexual and gender minority populations, including members of the lesbian, gay, bisexual, and queer communities, experience health disparities that stem from structural discrimination and barriers to care.1,2 As a result, members of sexual minority populations disproportionately face worse health outcomes compared with their heterosexual peers.3 Furthermore, patients who forgo or delay medical care and prescription medicine to save money may have worse health outcomes. While previous research has documented use of alternative therapies and cost-related medication nonadherence by race and ethnicity, no studies, to our knowledge, have examined whether adults from sexual minority groups engage in medication cost-saving strategies.4 We estimated behaviors regarding medications to save money by sexual orientation using nationally representative data in US adults from 2015-2018.
Data were obtained from the 2015-2018 National Health Interview Survey (NHIS), a nationally representative annual survey conducted in person. The family core questionnaire records basic health information for all household members. In NHIS 2015-2018, for each interviewed household (response rates, 64.2%-70.1%), a single random adult was selected (response rates, 79.7%-83.9%) for a detailed interview on health conditions, health behaviors, and access to care.5 Our sample was drawn from the sample adult component. This study was deemed exempt from review by the Vanderbilt University institutional review board. Verbal informed consent was obtained from each survey participant by the National Center for Health Statistics.
We examined 6 health behaviors in the context of saving money. These included the following: (1) used alternative therapies; (2) bought prescription drugs from another country; (3) skipped medication doses; (4) took less medication; (5) delayed prescription refills; and (6) asked a clinician for a lower-cost medication to save money (see Supplement for specific wording of questions). We compared these outcomes by self-reported sexual orientation using multivariable logistic regression models controlling for age category, sex, race and ethnicity, educational attainment, relationship status, health insurance status, number of chronic conditions, US Census region, and survey year. Results from all logistic regression models were presented as adjusted absolute risk differences (RDs) and odds ratios (ORs). Given the sociodemographic diversity among sexual minority individuals, estimates were calculated for sexual minority as a group and by subgroups (lesbian or gay, bisexual, other). Analyses were computed in Stata version 16 (StataCorp LP) using survey weights, and statistical significance was defined as a 2-sided α < .05.
Respondents (unweighted n = 114 696) reported their sexual orientation as heterosexual (weighted 96.9%), lesbian or gay (1.6%), bisexual (1.1%), or other (0.4%) (Table 1). Respondents who did not know the answer (n = 949) or declined responding to (n = 685) the sexual orientation question were excluded. After controlling for sociodemographic factors, compared with heterosexual individuals, individuals identifying as a sexual minority as a group were more likely to report reducing medication costs by using alternative therapies (8.2% vs 4.2%; absolute RD, 3.05% [95% CI, 1.91%-4.20%]; OR, 1.81 [95% CI, 1.51-2.16]), skipping medication doses (8.0% vs 5.8%; absolute RD, 1.50% [95% CI, 0.34%-2.65%]; OR, 1.30 [95% CI, 1.08-1.56]), taking less medication (8.4% vs 6.0%; absolute RD, 1.82% [95% CI, 0.62%-3.03%]; OR, 1.36 [95% CI, 1.13-1.63]), delaying prescription refills (11.9% vs 7.5%; absolute RD, 3.25% [95% CI, 1.86%-4.64%]; OR, 1.53 [95% CI, 1.30-1.79]), and asking a clinician for lower-cost medication (21.9% vs 19.2%; absolute RD, 4.22% [95% CI, 2.12%-6.32%]; OR, 1.30 [95% CI, 1.15-1.47]) (Table 2). Results varied by subgroup. For example, bisexual individuals were more likely to delay filling a prescription to save money (15.0% vs 7.5%; absolute RD, 4.31% [95% CI, 1.85%-6.77%]; OR, 1.71 [95% CI, 1.32-2.22]) than heterosexual individuals.
This study found modest increases in a number of self-reported behaviors to reduce medication costs among sexual minority adults compared with their heterosexual peers. This is especially concerning because individuals from sexual minority populations are disproportionately affected by certain conditions (eg, mood disorders, HIV, and cardiovascular disease), many of which require medical therapy.2,3 Poor knowledge about sexual minority issues among prescribers, difficulty navigating the health care system, and disparate social and financial supports may contribute to medication cost-saving behaviors among sexual minority adults.6 Future studies should explore interventions to minimize such behaviors among individuals who identify as a sexual minority. This study was limited by self-reported data and the proportion of respondents without sexual orientation data.
Corresponding Author: Rishub K. Das, BA, Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN 37232 (email@example.com).
Accepted for Publication: October 26, 2021.
Author Contributions: Mr Das and Dr Gonzales had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Both authors.
Critical revision of the manuscript for important intellectual content: Das.
Statistical analysis: Both authors.
Conflict of Interest Disclosures: None reported.