Addressing Health Disparities in Medication Safety Research

Every year, millions of people around the world suffer harm from medications that should have kept them safe. But not everyone is affected equally. People of color, older adults, non-English speakers, and low-income communities face higher risks of medication errors, worse outcomes, and less access to safe drug treatments. These aren’t accidents. They’re systemic failures built into how medication safety is studied, reported, and delivered.

Why Some Patients Are Left Behind

Medication safety research has long focused on broad statistics: how many errors happen, where they occur, and how much they cost. But behind those numbers are real people - people whose voices rarely make it into the data. A 2025 study across five NHS hospitals found that patients from certain racial and ethnic groups were far less likely to have their medication errors reported. Black and white patients had higher reporting rates, while Asian, Hispanic, and other minority groups showed significantly lower numbers. That doesn’t mean they had fewer errors. It means their concerns were ignored, misunderstood, or dismissed.

Language barriers play a huge role. A patient who doesn’t speak English may not understand how to describe side effects. They may not know they’re allowed to question a doctor’s instructions. In one documented case, a Spanish-speaking elder in California received the wrong dose of blood pressure medication because the hospital interpreter was unavailable, and the nurse relied on a family member who didn’t know medical terms. The error went unreported because no one asked the right questions.

Cultural mistrust adds another layer. Many Black and Indigenous patients have been failed by the medical system for generations. A 2024 study of public health students in Georgia found that clinicians often made assumptions about pain tolerance, adherence, or health literacy based on race. These biases lead to under-treatment, miscommunication, and ultimately, unsafe outcomes. When patients feel unheard, they stop speaking up - even when something goes wrong.

The Clinical Trial Gap

New medications are tested in clinical trials before they reach the public. But who gets to be in those trials? Not everyone. From 2014 to 2021, Black participants made up only about one-third of the population share for the diseases they were most affected by. For example, Black Americans have the highest rates of high blood pressure and kidney disease, yet they were severely underrepresented in trials for drugs meant to treat those conditions.

The consequences are dangerous. If a drug hasn’t been tested on your body type, your metabolism, or your genetic background, you don’t know if it’s safe for you. The FDA approved a new heart failure drug in 2023 that worked well in white patients but showed mixed results in Black patients - data that wasn’t collected because too few Black participants were enrolled. The same happened with COVID-19 vaccines. Even though Black and Latino communities were hit hardest, their representation in trials still lagged behind their share of the population.

This isn’t just about fairness. It’s about safety. Without diverse data, doctors can’t predict side effects, dosing needs, or drug interactions accurately for everyone. And when patients don’t trust the science behind a drug, they’re more likely to skip doses, avoid treatment, or turn to unregulated alternatives - all of which increase risk.

Who Can’t Afford Safe Medications?

Even when safe drugs exist, access is unequal. In 2022, nearly 19% of Hispanic Americans and 11.5% of Black Americans were uninsured. That’s compared to just 7.4% of white Americans. High out-of-pocket costs mean many can’t fill prescriptions, especially for newer, brand-name medications. A patient with diabetes might choose between insulin and rent. Someone with chronic pain might buy over-the-counter pills that interact dangerously with their other meds.

These choices aren’t made lightly. They’re forced by systems that don’t prioritize affordability as part of safety. The WHO estimates that medication errors cost $42 billion globally each year - but that number doesn’t include the hidden costs of people skipping doses, delaying care, or dying because they couldn’t afford the right drug.

How Bias Shows Up in Prescribing

Doctors don’t set out to harm patients. But unconscious bias creeps in. A 2024 study in JAMA Network Open found three main drivers of unsafe prescribing for marginalized groups: limited access to care, implicit bias in decision-making, and reliance on non-prescription alternatives.

For example, Black patients are less likely to be prescribed opioids for pain, even when they report the same levels of pain as white patients. But they’re also more likely to be prescribed higher-risk antipsychotics for behavioral issues - not because they’re more aggressive, but because clinicians assume they’re noncompliant or “difficult.”

In rural areas, elderly patients on multiple medications are often given new prescriptions without proper review. Pharmacists may not have time to check for interactions. Electronic alerts get ignored. The result? A 78-year-old Native American woman in Arizona ended up in the ER after her new antidepressant clashed with her blood pressure pill - a combo that should have been flagged by her EHR. But the system didn’t flag it because the algorithm was trained mostly on data from younger, white patients.

What’s Being Done - and What’s Missing

There are efforts to fix this. The World Health Organization’s Medication Without Harm initiative, launched in 2017, includes equity as a core goal. The Joint Commission now lists improving health equity as a formal patient safety goal. Some hospitals are training staff in cultural competency. Others are hiring bilingual patient advocates.

But progress is slow. A 2024 survey by the American Hospital Association found that only 32% of U.S. hospitals have formal programs to address medication safety disparities - even though 78% say it’s a priority. That gap between recognition and action is dangerous.

Technology can help - but only if it’s designed right. In 2024, the Office of the National Coordinator for Health Information Technology launched a $15 million project to build AI tools that detect medication safety disparities in electronic records. These tools could flag when a certain group is being prescribed higher-risk drugs, or when patients are missing follow-ups. But if the AI is trained on biased data, it will just repeat the same mistakes.

What Needs to Change

Real progress requires more than training or tech. It needs structural change.

• Collect better data. Every medication safety report must include race, language, income, and insurance status - not as checkboxes, but as critical variables. Without this, we can’t see the patterns.
• Fix clinical trials. Regulators should require diverse enrollment targets for new drugs. If a drug targets a condition that affects Black people at twice the rate of white people, the trial should reflect that.
• Invest in language access. Hospitals need real-time professional interpreters - not apps or family members. This isn’t a luxury. It’s a safety requirement.
• Engage communities. Patient advocacy groups, faith leaders, and local organizers know what’s happening on the ground. They need seats at the table when safety protocols are designed.
• Hold systems accountable. Hospitals should be rated on equity outcomes, not just error rates. If a hospital has high medication error rates among Latino patients, that should trigger an audit - not a memo.

The Bottom Line

Medication safety isn’t just about pills and prescriptions. It’s about power, trust, and who gets to be heard. When we ignore disparities in research, we don’t just miss data - we miss lives. The same drugs that save one person can harm another, not because of biology, but because of bias, poverty, and broken systems.

The tools to fix this exist. What’s missing is the will. Until healthcare systems treat equity as a core safety issue - not an add-on - the same people will keep getting left behind. And that’s not just unfair. It’s deadly.