In 2007, expenditures for prescriptiondrugs were $227.5 billion, and are ex-

pected to reach $453.7 billion by 2018.1

Although prescription drug spending ac-counted for only 10% of national health-care spending,2 it had been rising at dou-ble-digit rates in the late 1990s and early2000s. Prescription drugs may promoteefficient healthcare delivery and can sig-nificantly increase healthcare quality andlife expectancy of patients while reduc-ing total healthcare costs.3-5 Despite theimportance of drug therapy in properhealthcare treatment regimens, many mi-norities face challenges in accessing af-fordable medications.

Figure 1 shows the top 5 minoritygroups in the US according to US Cen-sus Bureau statistics in 2007. As thelargest minority group, Latinos com-prised approximately 45.5 million sub-jects in the US in 2007, and are expectedto reach 132.8 million, almost 30% ofthe country’s population, by 2050.6 Theyare disproportionately affected by thelack of affordable prescription drugscompared to non-Latino whites.7-10 Wor-king-age Latinos were significantly morelikely than whites to report that they could not afford pre-scription drugs. According to a study by the Center forStudying Health System Change (HSC), 1 in 6 adult (aged18–64 y) Latinos could not afford necessary prescription

drugs due to their cost, compared to approximately 1 in 10adult whites in 2001.11

Because of their large absolute size, there is significant di-versity among the Latino population. Previous studies report-ed significant variations in healthcare access, utilization, andoutcomes among Latino subgroups.12-18 However, none ofthese studies had examined disparities among Latinos in

The Annals of Pharmacotherapy n 2010 January, Volume 44 n

Latino Disparities in Prescription Drug Use and Expenditures:

A Nationally Representative Analysis

Jie Chen, Hai Fang, Arturo Vargas-Bustamante, John A Rizzo, and Alexander N Ortega

theannals.com

Public Health

Author information provided at end of text.

BACKGROUND: Latinos are disproportionately affected by the lack of affordable pre-scription drugs. Within the Latino population, there are significant heterogeneitiesin the patterns of prescription drug expenditures and use. However, studies havetraditionally treated them as a single, monolithic group.

OBJECTIVES: To identify and quantify factors associated with disparities in druguse and expenditures between non-Latino whites and Latino subgroups.

METHODS: We examined trends in prescription drug use, total prescription drugexpenditures, and the proportion of out-of-pocket (OOP) payment to total drugexpenditures for whites and Latino subgroups using the Medical ExpenditurePanel Survey from 1999 to 2006. Multivariate regressions were used to adjust forconfounding factors that may also affect drug use and expenditures.

RESULTS: Latinos were significantly less likely to use drugs compared to whites.Mexicans had significantly lower prescription drug costs and a higher proportionof OOP expenditures compared to whites after socioeconomic and demographicfactors were controlled. Usual source of care, health insurance, and limitedEnglish proficiency were the most important factors associated with thesedisparities. Among the Latino subgroups, Puerto Ricans had drug expendituresand use patterns most similar to those of whites.

CONCLUSIONS: Substantive disparities in prescription drug expenditures and useexisted between whites and specific Latinos groups, with Mexicans faring theworst. Future health studies should examine Latino subgroups separately, ratherthan treating Latinos as a homogeneous group. Policies aimed at expandinginsurance coverage and access to a usual source of care, as well as addressinglanguage barriers, should substantially reduce these disparities.

KEY WORDS: disparities, drug cost, Hispanic Americans, Latinos.

Ann Pharmacother 2010;44:57-69.

Published Online, 5 Jan 2010, theannals.com, DOI 10.1345/aph.1M467

RESEARCH REPORTS

terms of prescription drug use and expenditure. ConsideringLatinos as a monolithic group may overlook important differ-ences and behaviors associated with each Latino subgroup.

Using the Medical Expenditure Panel Survey (MEPS)data from 1999 to 2006, we measured disparities in theprobability of purchasing any prescription drug and theamount of drug expenditures and use between whites andeach of the following US Latino subgroups: Puerto Rican,Mexican, Cuban, Central/South American, and other Lati-nos. Greater cost sharing (ie, consumers paying a higherproportion of total costs) has been widely adopted to con-trol soaring pharmaceutical costs.19 However, delaying orforgoing necessary drug treatment due to increasing out-of-pocket (OOP) payments can lead to future hospital ad-missions and emergency department visits, thus raising to-tal healthcare costs.20-24 We calculated the proportion ofOOP payments among total drug expenditures for eachethnicity group to examine cost sharing differences.

We used the Blinder-Oaxaca decomposition method toidentify the importance of observable factors versus unob-served factors in explaining disparities in drug expenditureand use.24,25 This regression-based technique was originallyemployed to study the reasons for gender differences in earn-ings. But in recent years, it has been increasingly employedto understand healthcare disparities.26 This technique wasemployed in our study to determine the extent to which dis-parities in prescription drug uses and expenditures betweenwhites and each Latino subgroup reflected by observed andunobserved factors across ethnic groups and to quantify theimportance of specific factors in explaining these disparities.

Methods

DATA

We used data from the 1999–2006 MEPS conducted bythe Agency for Healthcare Research and Quality (AHRQ).27

The MEPS is a nationally representative survey of thecivilian, noninstitutionalized population in the US, withoversampling of racial and ethnic minorities to produce re-liable subgroup estimates. MEPS’s respondents, on aver-age, are interviewed 5 times over 2 years. The overall re-sponse rate averages from 60% to 70%.

The MEPS Consolidated File is a person-year leveldatabase that provides detailed consumer information onprescription drug utilization, total prescription drug cost,OOP payment, and patients’ demographics, socioeconom-ic characteristics, health, and health insurance status. TheMEPS Household Component collects data in each inter-view on drug use and expenditures. MEPS MedicalProvider Component is a follow-up survey that collectsdata from medical providers and pharmacies to validatedata on prescription drug use reported in the householdsurvey. These variables represent a full year of prescriptiondrug use and expenditures. Using this dataset, we wereable to estimate drug use and costs for each respondentduring the survey year.

MEPS also provides specific Latino group identifica-tion. We grouped the Latino sub-ethnicities as follows:Puerto Ricans, Mexicans, Cubans, Central/South Ameri-cans, and other Latinos.26,28,29 To capture the citizenship/na-tivity effect in the drug expenditure and use models, welinked MEPS to the National Health Interview Survey(NHIS) for each survey year to obtain information on indi-vidual citizenship and immigration status.30 After mergingthese 2 data files, we had an available sample of 104,742white and Latino subjects aged 18–64 years. We omittedelderly (≥65 y) subjects because this cohort was coveredby Medicare. After excluding 2073 observations withmissing information in the study variables, our final sam-ple included 72,160 whites, 2287 Puerto Ricans, 20,838Mexicans, 1736 Cubans, 3890 Central/South Americans,and 1758 other Latinos.

CONCEPTUAL FRAMEWORK

The conceptual framework for this study is the behav-ioral model developed by Andersen.31 According to thismodel, prescription drug expenditure and use are deter-mined by predisposing, enabling, and need factors.

Predisposing Factors

Predisposing factors included characteristics such as age,sex, marital status, and education. Language and citizenship/immigration status are important acculturation indicators af-fecting healthcare expenditure and use as well.30,32-37 An En-glish proficiency variable was constructed, which equaled 1if the interview was conducted in English and 0 otherwise.The NHIS dataset provides information on a subject’s citi-zenship and birthplace. Using this information, we construct-

n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Figure 1. Top 5 minorities in the US. Data Source: US Census Bureaureleased report on May 1, 2008. The population number was updatedon July 1, 2007. www.census.gov/PressRelease/www/releases/archives/population/011910.html (accessed 2009 Sept 24).

ed 3 mutually exclusive dichotomous measures of citizenshipand immigration: (1) US-born citizen, (2) naturalized US citi-zen (if the participant was a US citizen but was not born inthe US), and (3) non-US citizen.

Enabling Factors

Enabling factors included health insurance coverage andother socioeconomic factors. Health insurance coveragewas measured by dichotomous variables indicatingwhether the subject was covered by Medicaid, Medicare,other public health insurance, a private health maintenanceorganization (HMO) plan, a private non-HMO plan, orwas uninsured. Medicare was included because it coveredsome adults less than 65 years of age who had specificconditions, such as end-stage renal disease, or other dis-abilities. Socioeconomic variables included family income,employment status, whether the subject had a regularsource of health care, metropolitan statistical area location(urban or rural), and US Census Region dummies.

Need Factors

Need factors included self-perceived health status, dum-my variables measuring whether the patient had activitiesof daily living limitations or instrumental activities of dailyliving limitations.

STATISTICAL ANALYSIS

We used a 2-part model to examine drug expenditureand use.38 Specifically, we constructed a binary variablethat equaled 1 if the subject had used any prescription drugduring the survey year and 0 otherwise. For those who hadused any prescription drugs, we calculated total drug ex-penditures and the proportion of self payment (OOP)among total drug expenditures for each subject. All drugexpenditures were adjusted to constant dollars using theMedical Care Component of the Consumer Price Index,with 2006 as the base year.

We calculated the probability of using any prescriptiondrug, total drug expenditure, and the proportion of OOP forsubjects in each ethnic group from 1999 to 2006 and present-ed the results in figures. We employed bivariate analyses tocompare the expenditure and use patterns across the groupsin the pooled sample. χ2 Tests were used to test significantdifferences for categorical variables, and t-tests were used forcontinuous variables. p Values were reported to comparewhites with each Latino subgroup. Summary statistics forconfounding variables used in our multivariate analyses werealso presented across the groups.

To examine the adjusted effects of each Latino subgroupon drug expenditure, we employed multivariate analyses ofthe probability of taking any drug (logistic regressions) andthe amount of total drug expenditures and the proportion ofOOP payment (ordinary least squares regressions). We took

the natural logarithm of the total drug expenditure measure toadjust for its skewed distribution.39,40 All regressions were ad-justed using sampling weights provided by MEPS to ensurethat the results are nationally representative in the US.

We then employed Blinder-Oaxaca decomposition tech-niques to determine the extent to which utilization and ex-penditure disparities reflected differences in observablepopulation characteristics and to identify the most impor-tant factors associated with these disparities. The Blinder-Oaxaca approach is a regression-based method. For exam-ple, to decompose the disparities of pharmaceutical expen-ditures (or OOP share) between whites and Mexicans, wefirst estimated ordinary least square regressions for phar-maceutical expenditures (or OOP share) for whites andeach Latino subgroup (eg, Mexican Americans), respec-tively. Then we used the estimated coefficients and themean values of all the independent variables to calculatethe predicted costs for each group (these results are omit-ted in the interest of brevity but are available from the au-thors on request). We then subtracted these 2 estimatedequations and decomposed these differences into 2 parts:(1) differences due to the observed factors and (2) differ-ences due to unobserved heterogeneities associated withrace/ethnicity, such as cultural background and be-liefs.24,25,41,42 We repeated this procedure to examine ethnicdisparities between whites and each Latino subgroup.Nonlinear Blinder-Oaxaca methods were applied to the re-gressions that estimated the probability of taking any drug(as a binary measure) following Fairlie.41

Results

DRUG TRENDS FROM 1999 THROUGH 2006

Prescription drug use was fairly stable over time, asshown in Figure 2. Thus, approximately 70% of whites usedprescription drugs during each year. There were significantvariations in drug use among the Latino subgroups, howev-er. Approximately 60% of Puerto Ricans used prescriptiondrugs, followed by “other” Latinos and Cubans. Mexicansand Central/South Americans were least likely (40–50%, re-spectively) to take any prescription drugs.

Figure 3 shows total drug expenditures and Figure 4shows OOP payment shares from 1999 to 2006. Cubansand Puerto Ricans encountered the highest drug expendi-tures during these years, followed by whites. Mexicansand Central/South Americans spent the least on prescribeddrugs in total, but incurred the highest proportion of OOPcompared to any other groups. Puerto Ricans spent theleast proportion OOP on pharmaceuticals.

BIVARIATE ANALYSES

Table 1 summarizes the sample characteristics of studyvariables. Pooling all survey years, we found that whites

Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com

were significantly more likely to take any prescriptiondrug than any Latino subgroup (p < 0.001). Puerto Ricanshad the highest total drug costs compared to other groups(p < 0.001) and Mexicans and Central/South Americanshad the lowest total expenditures. In contrast, Mexican andCentral/South Americans self-paid for 61% of their pre-scription drugs, while OOP payments for Puerto Ricansand whites were only 46% and 50%, respectively. Whitesalso had better healthcare access than Latino groups. Ap-proximately 80% of whites had a usual source of care,which was 25 percentage points more likely than Mexi-cans and Central/South Americans (p < 0.001). Whiteswere twice as likely to have private non-HMO health planscompared to any other Latino groups (p < 0.001) and lesslikely to have Medicaid (p < 0.001). Almost all of thewhites were interviewed in English, compared to 42% ofMexicans, 51% of Cubans, and 37% of Central/SouthAmericans (p < 0.001).

MULTIVARIATE REGRESSIONS

In the multivariate regressions, Latinos remained signif-icantly less likely to use any prescribed drug relative towhites (Table 2). Among the Latino subgroups, Mexicansand Cubans, respectively, were least likely (OR 0.66 [95%CI 0.62 to 0.70] vs 1.00 and OR 0.62 [95% CI 0.54 to0.71] vs 1.00; p < 0.001) and Puerto Ricans were mostlikely (OR 0.76 [95% CI 0.67 to 0.87] vs 1.00; p < 0.001)to take any drug.

Compared to private HMO plans, people enrolled inother health insurance plans, particularly in Medicare andMedicaid, were much more likely (OR 1.72 [95% CI1.38 to 2.05] vs OR 1.89 [95% CI 1.73 to 2.03]; p <0.001) to take pharmaceuticals. People with a usualsource of healthcare were more than 3 times as likely touse any pharmaceutical (OR 3.35 [95% CI 3.21 to 3.48];p < 0.001) than those without a usual source of health-care. People who spoke English were 28% more likely(OR 1.28 [95% CI 1.18 to 1.38]; p < 0.001) to use pre-scription drugs.

In the multivariate regressions for total drug expendi-tures, Mexicans, Puerto Ricans, Central/South Americans,and other Latinos had significantly lower expendituresthan whites (p < 0.001), while there were no significantdifferences between whites and Cubans. Among the Lati-no groups, Mexicans paid a higher proportion of OOP andPuerto Ricans paid a lower proportion of OOP comparedto whites, after adjusting for all of the covariates (p <0.050).

Year dummies measure the aggregate market effects onthe drug use over time. Compared to 1999, people wereless likely to use any drug from 2002 to 2006 (OR 0.82 to0.96, p < 0.001), and total prescription drug expenditureswere also lower compared to those in 1999.

n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Figure 4. Trends of proportions of out-of-pocket (OOP) payment to to-tal prescription drug costs.Figure 3. Trends of total prescription drug costs.

Figure 2. Trends of probability of having used any prescription drug.

DECOMPOSITION RESULTS

The top panel in Table 3 shows the decomposition re-sults for the probability of having used any prescriptiondrugs. Observed differences in population characteristicsexplained 40% (whites vs Puerto Ricans), 66.7% (whitesvs Mexicans), 75% (whites vs Cubans), 79.9% (whites vsCentral/South Americans), and 80% (whites vs other Lati-nos) of drug use differences.

Among the specific factors explaining these observabledifferences, healthcare access was the most important fac-tor affecting the disparity between whites versus each Lati-no subgroup, except for Puerto Ricans. Language was thesecond most important factor associated with disparitiesbetween whites and each Latino subgroup, again with theexception of Puerto Ricans. For Puerto Ricans, health in-surance was the most important factor for these differ-ences, followed by having a usual source of care.

The middle panel in Table 3 shows the decompositionresults for total drug expenditures. Observed populationcharacteristics explained 57.5–97.1% of the difference intotal drug costs. Age difference was the most importantfactor associated with disparities, followed by citizen-ship/nativity. Among the enabling factors, having a usualsource of care was the most important factor to explain thecost disparities between whites and each Latino group,with the exception of Puerto Ricans.

The bottom panel in Table 3 shows the decompositionresults for the proportion of OOP payment to total drug ex-penditures. In the predicted proportions, only Puerto Ri-cans paid a lower share of OOP payment than whites. Allother Latino subgroups paid a higher share of OOP pay-ment than whites.

DRUG THERAPEUTIC CLASS AND BRAND/GENERIC

EFFECTS

The specific therapeutic classes of prescribed medicinesused and the generic and brand name status of drugs mightsignificantly influence drug use, cost, and OOP payment(we thank an anonymous reviewer for calling this point toour attention). To investigate these issues, we linked theMEPS Consolidated File to the MEPS Prescribed Medi-cines File to obtain the national drug code, allowing us toidentify the specific therapeutic class of drugs. We collect-ed information of brand and generic status of each pre-scription drug from the Orange Book provided by theFood and Drug Administration.

We summarized the total prescription drug use, numberof prescription drugs used, and the OOP shares for eachethnic group for 5 broadly prescribed medications: antihy-pertensive, antidepressant, drugs for hyperlipidemia, asth-ma, and nonsteroidal antiinflammatory drugs in Table 4.On average, whites had significantly higher drug costs and

used more prescription drugs during the year than Latinos.Mexicans still had significantly higher OOP shares thanwhites.

Among these 5 therapeutic drug classes, only 40% ofwhites took generic formulations, compared to 45% ofPuerto Ricans, 52% of Mexicans, 39% of Cubans, 48% ofCentral/South Americans, and 44% of other Latinos (re-sults are not presented). Blinder-Oaxaca decompositionsperformed for this subset of 5 major drug classes showedthat the Mexican group’s tendency to use generic drugssignificantly decreased the disparities of OOP shares be-tween them and whites. Without this difference, Mexicanswould pay a substantially higher share of OOP than theycurrently do. This finding is consistent with previous re-search.10

Discussion

Several studies have examined racial and ethnic dispari-ties in prescription drug utilization and expenditures.7-10 Al-though multiple reports have documented that Latinosgenerally use fewer pharmaceuticals and encounter lowerexpenditures compared to whites, there is little evidence ondifferences among Latino subgroups. It is important to as-sess the differential access to prescription drugs amongLatinos to improve access among the most vulnerable pop-ulations.

Our study finds significant variations among Latinosubgroups in patterns of drug expenditures and use. PuertoRicans had drug expenditures and use patterns most simi-lar to those of whites, while the patterns for Mexicanswere far less favorable; Mexicans were the least likely totake any medication and had the lowest total expenditures,but had the highest proportion of OOP payment for theirdrugs. Both population demographic status and socioeco-nomic factors had significant impacts on these disparities.The age difference was an important component to explainthe underuse and lower expenditures of medications forMexicans. People 45–65 years of age use 2– 4 more pre-scription drugs than do individuals 18–34 years.43 Mexi-cans were younger on average compared to whites; thus,they were less likely to use prescription drugs, resulting inlower drug expenditures.

Less access to a usual source of care, however, was themost important enabling factor associated with the dispari-ties in drug utilizations, surpassing population characteris-tics. Approximately 80% of whites had a primary physi-cian with whom they could discuss their illness and ask forhealth advice. In contrast, just 55% of Mexicans had suchsources to obtain medical advice and medications.

Our findings also indicate that it is important to exam-ine the different impacts of health insurance on drug ex-penditure and use. Multivariate results showed that peo-ple enrolled in private non-HMO plans and Medicaid

Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com

n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Tabl

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Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com

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n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Tabl

e2.

Mul

tivar

iate

Reg

ress

ions

Use

An

yD

rug

Tota

lDru

gP

aym

ent

OO

PP

rop

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ion

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nici

ty

whi

tere

fre

fre

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ican

0.66

0.62

0.70

0.00

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.43

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10.

000.

010.

000.

020.

05

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an0.

760.

670.

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0.00

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an0.

620.

540.

710.

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90.

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250.

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0.04

0.56

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tral

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ican

0.69

0.62

0.77

0.00

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80.

000.

00–0

.02

0.02

0.94

othe

rLa

tinos

0.75

0.65

0.87

0.00

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30.

010.

040.

010.

060.

01

Age

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fre

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41.

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140.

060.

270.

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100.

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41.

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hip/

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Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com

exce

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n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Table 3. Decomposition Results

Probability of having any drug cost white = 0.69 (reference)

Puerto Rican Mexican Cuban Central/South American Other Latinos

Predicted probability 0.59 0.45 0.49 0.44 0.54

Total difference –0.10 –0.24 –0.20 –0.26 –0.15

Total explained –0.04 –0.16 –0.15 –0.21 –0.12

% explained 40 66.7 75 79.9 80

Significant factors

age –0.01 –0.03 –0.01 –0.02 –0.01

citizenship/nativity –0.02

education –0.02 –0.01

family income –0.01 –0.02

health status 0.01 0.01 0.01 0.01

private non-HMO –0.02 –0.02 –0.01 –0.02 –0.01

Medicaid 0.02 0.01 0.02

having USC –0.01 –0.06 –0.05 –0.07 –0.04

limited English proficiency –0.02 –0.03 –0.05

Amount of Ln (total drug cost) white = 5.81 (reference)

Puerto Rican Mexican Cuban Central/South American Other Latinos

Predicted amount 5.65 5.08 5.46 5.09 5.37

Difference –0.16 –0.73 –0.35 –0.72 –0.44

Total –0.14 –0.42 –0.34 –0.50 –0.33

% explained 87.5 57.5 97.1 69.4 75

Significant factors

age –0.11 –0.14 –0.10 –0.09

citizenship/nativity –0.12 –0.10 –0.10 –0.19 –0.11

education –0.05 –0.07 –0.03 –0.04 –0.03

family income –0.04 –0.04 –0.03 –0.02 –0.05

unemployed 0.03 0.02 0.02 0.01 0.02

health status 0.14 0.14 0.12 0.08 0.06

private non-HMO –0.02 –0.03 –0.02 –0.03 –0.02

Medicaid 0.04 0.02 0.02 0.01 0.03

having USC –0.08 –0.07 –0.10 –0.05

US Census regions –0.02 –0.03 0.02 –0.02 –0.02

Proportion of OOP payments to total drug cost white = 0.50 (reference)

Puerto Rican Mexican Cuban Central/South American Other Latinos

Predicted proportion 0.46 0.60 0.57 0.60 0.57

Difference –0.03 0.10 0.08 0.10 0.07

Total –0.03 0.06 0.04 0.06 0.01

% explained 100 60 50 60 14.3

Significant factors

age 0.01 0.01

citizenship/nativity 0.02 0.01 0.04 0.01

education 0.01 0.01 0.01 0.01 0.01

family income 0.02 0.02 0.02 0.02 0.02

private non-HMO 0.01 0.01 0.01 0.01 0.01

Medicaid –0.07 –0.03 –0.03 –0.02 –0.05

health –0.003 –0.003 –0.001

having USC 0.01 0.01 0.01 0.01

HMO = health maintenance organization; Ln = the natural log; OOP = out-of pocket; USC = usual source of care.

were more likely to use drugs, had higher drug costs,and had lower OOP payment compared to those enrolledin private HMO plans. People enrolled in private non-HMO plans shared relatively lower OOP payment.Compared to whites, Latinos were less likely to enroll inprivate non-HMO plans that might have increased theircost sharing for prescription drugs. Latinos were morelikely to be enrolled in Medicaid and people enrolled inMedicaid paid significantly lower OOP amounts. Thesedifferences may have explained their lower OOP pay-ments as well. These factors offset each other, so that wedid not see large racial and ethnic disparities overall.However, this is due to the importance of Medicaid cov-erage. If there were not extensive Medicaid drug cover-age for Latinos, they would pay a significantly highershare of OOP than whites, much more than what theypay now.

Citizenship/nativity and English language proficiencyalso explain significant portions of the disparities betweenwhites and Latinos. The disadvantages in access to generalhealth care among non-US citizens and people who do notspeak English have been well documented.32-34 Our studyfound that these disparities persist in terms of drug expen-ditures and use.

People in better health are significantly less likely totake any prescription drug and have lower drug costs.Our summary statistics show that average total drugcosts and OOP payments for people in excellent healthare $251.66 and $102.09, respectively, which is muchlower than people in poor health, $3326.15 and$1183.96, respectively. (These results are not reportedhere but are available upon request from the authors.) Inour sample, Latinos, on average, were in worse healththan whites. Our decomposition results show that thishealth status difference explained a significant portion ofthe disparities in drug use and expenditures. If Latinoswere as healthy as whites, they would be even less likelyto take drugs and would have even lower drug expendi-tures.

Our findings for prescription drug use and expendituretrends are consistent with previous research. The KaiserFamily Report on prescription drug use shows that the an-nual rate of prescription drug use and spending declinedsince 1999, which might reflect “the slowdown in Medi-caid drug spending, the increased use of generic drugs(driven in part by the proliferation of tiered copaymentbenefit plans), changes in the types of drugs used, and adecrease in the number of new drugs introduced.”1

Our study has some limitations. First, data on medicalexpenditures and utilization were self-reported and may besubject to measurement error. Second, although we con-trolled for a number of predisposing, enabling, and needfactors that should predict pharmaceutical expenditure anduse, it is possible that some potentially important factor orfactors may have been excluded due to data limitations.Third, we have information only on the prescribedmedicines that patients had actually used. We do not haveinformation on physician behaviors; thus, we were unableto determine the number of medicines that were actuallyprescribed. Fourth, some of the statistically significant re-sults may not be of practical importance and are significantonly because our sample size is quite large.

Our study shows substantial variation in drug use andexpenditure among different Latino subgroups. Futurehealth services research studies should consider examiningLatino subgroups separately, rather than treating this groupas homogeneous. Disparities in prescription drug use andexpenditure exist between whites and Latinos, with Mexi-cans faring markedly worse among the Latino subgroups.Population characteristics associated with access, insur-ance, age, citizenship/nativity, and limited English profi-ciency are important determinants of these disparities.

Policies aimed at expanding availability of a usualsource of health care for Latinos can significantly alleviatethese disparities in drug use and expenditures. To reduceMedicaid coverage or to increase drug cost sharing wouldhave especially adverse effects on people with low in-comes, especially Mexican Americans.

Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com

Table 4. Summary Statistics for Five Specific Drug Categoriesa

Parameter Total Drug Expenditure Number of Prescriptions OOP Proportion

White 386.21 ± 465.14 4.90 ± 4.00 0.28 ± 0.22

Puerto Rican 367.32 ± 471.63 4.79 ± 3.88 0.25 ± 0.24

Mexican 289.84 ± 395.12 4.11 ± 3.73 0.29 ± 0.23

Cuban 389.74 ± 537.89 5.09 ± 4.41 0.29 ± 0.24

Central/South American 333.71 ± 506.19 4.20 ± 3.84 0.28 ± 0.23

Other Latinos 312.86 ± 470.99 4.67 ± 4.67 0.24 ± 0.22

OOP = out of pocket.aMean ± SD.

Jie Chen PhD, Assistant Professor, Department of Political Sci-ence, Economics, and Philosophy, College of Staten Island/City Uni-versity of New York, Staten Island, NYHai Fang PhD MPH, Assistant Professor, Department of HealthSystems, Management, and Policy, Colorado School of Public Health,University of Colorado, DenverArturo Vargas-Bustamante PhD, Assistant Professor, Depart-ment of Health Services, School of Public Health, University of Cal-ifornia, Los AngelesJohn A Rizzo PhD, Professor, Department of Economics and De-partment of Preventive Medicine, Stony Brook University, StonyBrook, NYAlexander N Ortega MPH PhD, Professor, Department of HealthServices, School of Public Health, University of California, Los AngelesReprints: Dr. Chen, Department of Political Science, Economics,and Philosophy, College of Staten Island/City University of New York,2800 Victory Blvd., Room 2N-229, Staten Island, NY 10314, fax718/982-2888, jiechen@mail.csi.cuny.edu

Financial disclosure: Dr. Chen received Diversity Projects De-velopment Funding sponsored by University Affirmative Action Com-mittee and a PSC-CUNY grant sponsored by University Committeeon Research Award. Dr. Ortega received a National Institute of Men-tal Health grant (R01 MH069849).

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n The Annals of Pharmacotherapy n 2010 January, Volume 44 theannals.com

J Chen et al.

Disparidad en el Uso y Gastos de Fármacos de Receta entre Latinos:Un Análisis Nacionalmente Representativo

J Chen, H Fang, A Vargas-Bustamante, JA Rizzo, y AN Ortega

Ann Pharmacother 2010;44:57-69.

EXTRACTO

TRASFONDO: Los latinos están desproporcionalmente afectados por la faltade fármacos asequibles. Dentro de la población latina existe heterogenei-dad en los patrones de uso y gastos de fármacos de receta. Sin embargo,los estudios tradicionalmente los han tratados como un grupo monolítico.

OBJETIVOS: Identificar y cuantificar los factores asociados a la disparidaden el uso y gastos de medicamentos de receta entre blancos y sub-gruposde latinos.

MÉTODOS: Se examinó las tendencias en el uso de medicamentos de receta,gastos totales en medicamentos de receta, y la proporción pagada por elpaciente entre los blancos y los sub-grupos latinos utilizando la encuesta“Medical Expenditure Panel Survey” entre 1999 a 2006. Se utilizóregresión multivariable para ajustar para otros factores que pudiesenafectar el uso y gastos de fármacos.

RESULTADOS: Los latinos usaban significativamente menos medicamentosque los blancos. Los mejicanos tuvieron significativamente menos gastosen medicamentos de receta y la proporción más alta pagada por el pacientecomparado con los blancos, luego de ajustar por factores socioeconómicosy demográficos. La fuente usual de cuidado, el seguro de salud, y elpoco dominio del idioma inglés fueron los factores más importantesasociados a esta disparidad. Dentro de los sub-grupos de latinos, lospuertorriqueños tuvieron los gastos y patrones de uso de medicamentosmás similares a los de los blancos.

CONCLUSIONES: Existe disparidad sustancial en el uso y gastos por medica-mentos de receta entre los blancos y grupos específicos de latinos, conlos mejicanos luciendo peores. Estudios futuros de salud deben examinarlos sub-grupos de latinos por separado en vez de tratar a los latinoscomo un grupo homogéneo. Las políticas dirigidas a expandir cubiertade seguros y acceso a las fuentes usuales de servicios de salud, así comoatender las barreras del lenguaje, deberían reducir sustancialmente lasdisparidades existentes.

Traducido por Giselle Rivera-Miranda

Différences Entre l’Utilisation des Médicaments sous Prescription etdes Dépenses Chez la Population Latino: une AnalyseReprésentative Nationale

J Chen, H Fang, A Vargas-Bustamante, JA Rizzo, et AN Ortega

Ann Pharmacother 2010;44:57-69.

RÉSUMÉ

OBJECTIF: Identifier et quantifier les facteurs associés avec les différencesdans l’utilisation des médicaments prescrits et les dépenses chez unepopulation de race blanche et des sous groupes d’une population Latino.

MÉTHODES: Les auteurs ont évalué les tendances de 1999 à 2006 dansl’utilisation des médicaments prescrits, les dépenses totales des pre-scriptions et la fréquence de frais remboursable chez une population derace blanche et des sous groupes d’une population Latino en utilisantl’étude Medical Expenditure Panel. Des régressions multivariables ontété utilisées pour ajuster les facteurs confondants qui peuvent affecterl’utilisation et les dépenses des médicaments.

RÉSULTATS: La population d’origine Latino utilisait moins de médicamentslorsque comparé à la population caucasienne. Les Mexicains avaient uncoût significativement moins élevé des médicaments prescrits et uneproportion plus élevée de frais remboursables lorsque comparé à la pop-ulation caucasienne après avoir contrôlé pour les facteurs socio-écono-miques et démographiques. Les soins usuels de santé, l’assurance maladie,et les compétences limitées en anglais représentaient des facteurs impor-tants qui expliquaient ces différences. Lorsque les sous groupes de lapopulation Latino ont été analysés, les Portoricains avaient de dépenseset des habitudes d’utilisation semblables à celle de la population de raceblanche.

CONCLUSIONS: Des différences importantes dans les dépenses des médi-caments et leurs utilisations ont été observées entre la population de raceblanche et les groupes Latino, spécifiquement chez les Mexicains. Desétudes devraient étudier ces sous groupes séparément au lieu d’inclureles Latinos comme étant un groupe homogène.

Traduit par Louise Mallet

Latino Disparities in Prescription Drug Use and Expenditures

The Annals of Pharmacotherapy n 2010 January, Volume 44 ntheannals.com