Taux de vaccination et hésitation chez les personnes noires: Disparities in cost-related prescription nonadherence between Black and White adults in Canada

Background: 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. Methods: 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. Results: 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).