Disparities in cost-related prescription nonadherence between Black and White adults in Canada

Cost-related prescription nonadherence is a prominent barrier that may affect health outcomes in Black communities in Canada. We aimed to assess the prevalence of cost-related prescription nonadherence among Black adults in Canada and to investigate racial disparities in comparison to White adults, accounting for demographic, socioeconomic, and insurance coverage factors as potential mediators.

We conducted a cross-sectional study using pooled data from 5 cycles of the Canadian Community Health Survey. The outcome was self-reported cost-related prescription nonadherence. We used a hierarchical framework and applied multivariable Poisson regression to estimate weighted adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs). We used weights provided by Statistics Canada to provide estimates representative of the Canadian population.

Respondents to the survey included 2997 Black and 178 514 White adults; after weighting, the average population size was 16 544 715, 3.6% of whom identified as Black. Among Black adults, the prevalence of cost-related prescription nonadherence declined from 15.3% in 2015 to 9.5% in 2022, compared with a decrease from 6.0% to 5.5% among White adults. Prescription medication coverage among Black adults was 71.6% in 2015 and 72.5% in 2022, compared with 83% and 80% among White adults, respectively. The prevalence of cost-related prescription nonadherence was 75% higher among Black adults than among their White counterparts (average 12.2% v. 5.8%; adjusted PR 1.75, 95% CI 1.43 to 2.14), while prescription medication coverage was less frequent among Black adults. After adjusting for potential mediators, Black cultural or racial background remained associated with cost-related prescription nonadherence (adjusted PR 1.36, 95% CI 1.13 to 1.64). Prescription medication coverage was associated with a lower likelihood of cost-related prescription nonadherence (adjusted PR 0.44, 95% CI 0.41 to 0.46).

Cost-related prescription nonadherence was significantly higher among Black adults in Canada, both before and after adjusting for potential mediators. Addressing disparities in prescription medication coverage and associated barriers is essential to promoting equitable access to health care.