Implications of Costly Medications for Sexual Minorities

It is well documented that LGBTQ+ individuals are at higher risk of chronic disease burden for a wide range of conditions such as mood disorders, HIV, and cardiovascular disease. These conditions typically require medication management. Inability to access medications may be one factor that contributes to health disparities experienced by sexual minorities.

Few surveys include information on how individuals reduce medication-related costs. The National Health Interview Survey is one important exception: it asks thousands of adults in the United States every year about behaviors such as using alternative therapies, skipping medication doses, taking less medication than prescribed, delaying refilling prescriptions, and asking clinicians for lower-cost medications.

This survey is also unique in that it has included information about an individual's sexual orientation for the past several years. Questions about health insurance coverage and socioeconomic factors that may also contribute to behaviors to reduce medication costs are also asked, meaning that researchers can control for such differences to try to isolate the independent association between minority sexual orientation and the cost-related medication behaviors.

Vanderbilt's Approach:

Gilbert Gonzales, associate professor of Medicine, Health, and Society and director of the Program in Public Policy Studies, has collaborated with School of Medicine student Rishub K. Das to study this question, which is important for understanding health equity related for LGBTQ people. Published in the Journal of the American Medical Association, their study found that, compared to heterosexual individuals with the same characteristics, sexual minority adults were more likely to exhibit all of the cost-related behaviors mentioned above. Given the consistent trend of rising medication costs in the United States, Dr. Gonzales' results have meaningful implications for understanding health equity for sexual minority communities.

This analysis is one of many such collaborations between Dr. Gonzales and mentees, trainees, and students in the College of Arts and Science and the Vanderbilt University School of Medicine. For example, Dr. Gonzales has also published research examining frequent use of emergency rooms by sexual minorities with another VUSM alumnus, and he has also published scholarship with a VUSM PhD student (Nathaniel Tran) and postdoctoral scholar on the association between adverse childhood experiences (ACES) and adult mental distress for sexual minorities. The G^2 Lab (Gilbert Gonzales Lab) has contributed to the training of numerous students and postdoctoral scholars who have gone on to further training in medicine, public health, and related fields.