Cost-related barriers to medication use among diverse participants with obesity-associated asthma

Individuals with obesity-associated asthma (OAA) have worse health outcomes than those with asthma and healthy weight (no OAA). The impact of cost barriers on medication use and how it varies by racial and ethnic groups is unclear.

To assess the impact of cost barriers on medication use in OAA across racial and ethnic groups.

This cross-sectional study included adults with asthma who participated in the All of Us program between May 2017 and August 2024. OAA was defined as having both asthma (confirmed by the electronic health record) and obesity (body mass index [BMI]≥30 kg/m²). Main measures included self-reported cost-related barriers to medication use.

A total of 21,108 patients (mean age 58.9 years, 73.6% female, 11.9% Hispanic/Latinx, 67.2% non-Hispanic White, 13.0% non-Hispanic Black, 1.5% non-Hispanic Asian, and 6.3% other) were included, with 51.7% having OAA (mean BMI of 38.6 kg/m²). Individuals with OAA had higher odds of experiencing cost-related barriers (adjusted odds ratio [aOR] range = 1.12-1.31, all P < 0.05) vs those without OAA. Despite greater affordability challenges, non-Hispanic Black (aOR = 0.82, 95% CI = 0.69-0.96, P = 0.013) and Hispanic individuals (aOR = 0.80, 95% CI = 0.65-0.98, P = 0.033) with OAA were less likely to skip medications compared with non-Hispanic White individuals. Both groups were also less likely to request lower-cost alternatives (aOR = 0.72, 95% CI = 0.64-0.82, P < 0.001; aOR = 0.65, 95% CI = 0.55-0.77, P < 0.001, respectively).

Significant disparities exist in cost-related barriers among individuals with OAA from different ethnic backgrounds. This highlights the need for tailored health care interventions that address the specific needs of diverse populations, aiming to reduce health disparities and improve asthma outcomes.