Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs

Seth A Berkowitz,Hilary K Seligman,Niteesh K Choudhry

doi:10.1016/j.amjmed.2014.01.002

Abstract

BackgroundAdults with chronic disease are often unable to meet medication and food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. MethodsCross-sectional analysis of data from chronically ill participants (self-report of arthritis, diabetes mellitus, cancer, asthma, chronic obstructive pulmonary disease, stroke, hypertension, coronary heart disease, or presence of a “psychiatric problem”) aged ≥20 years, in the 2011 National Health Interview Survey. We fit logistic regression models to identify factors associated with food insecurity, cost-related medication underuse, or both. ResultsThere were 9696 adult National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. Adults who reported food insecurity were significantly more likely to report cost-related medication underuse (adjusted odds ratio [aOR] 4.03). Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic (aOR 1.58), non-Hispanic black (aOR 1.58), and have more chronic conditions (aOR per additional chronic condition 1.56) than patients reporting neither. They also were less likely to have public, non-Medicare insurance (aOR 0.70) and report participation in the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (aOR 0.39). ConclusionsApproximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both. WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse.

Highlights

The current economic climate has led to substantial hardship for many Americans
WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse
We used the 2011 National Health Interview Survey to understand how common these two aspects of economic insecurity are among individuals with chronic disease and, to inform policy-making, whether specific groups of patients, when both needs cannot be met, are more likely to report food insecurity, or vice versa

Summary

Introduction

The current economic climate has led to substantial hardship for many Americans. In 2012, one in six Americans report that they lack health insurance[1] and nearly one in five report trouble meeting basic needs[2]. While prescription drug benefit programs and food security assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) do exist, it is not clear if they are sufficient to mitigate the effects of food insecurity on medication underuse or the effects of out-of-pocket medication payments on food insecurity Both cost-related medication underuse and food insecurity are associated with adverse health consequences,(7-10) but no prior study has examined the relationship between them in a nationally representative sample. Adults who reported food insecurity were significantly more likely to report cost-related medication underuse (adjusted odds ratio [aOR] 4.03) Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic (aOR 1.58) non-Hispanic Black (aOR 1.58), and have more chronic conditions (aOR per additional chronic condition 1.56) than patients reporting neither. They were less likely to have Public, non-Medicare insurance (aOR 0.70) and report to WIC participation (aOR 0.39)

Methods

Results

Conclusion