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Am J Med. 2014 Apr;127(4):303-310.e3. doi: 10.1016/j.amjmed.2014.01.002. Epub 2014 Jan 17.

Treat or eat: food insecurity, cost-related medication underuse, and unmet needs.

Author information

1
General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address: SABerkowitz@partners.org.
2
Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, University of California San Francisco.
3
Department of Medicine, Harvard Medical School, Boston, Mass; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.

Abstract

BACKGROUND:

Adults 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.

METHODS:

Cross-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.

RESULTS:

There 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).

CONCLUSIONS:

Approximately 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.

KEYWORDS:

Chronic disease; Medication adherence; Population health; Socioeconomic factors; Underserved populations

PMID:
24440543
DOI:
10.1016/j.amjmed.2014.01.002
[Indexed for MEDLINE]

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