Clinical research studyTreat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs
Section snippets
Data Source and Study Sample
We analyzed data from the 2011 National Health Interview Survey (NHIS).11 The NHIS is conducted annually by trained in-person interviewers in English, Spanish, or with an interpreter. Full details of NHIS methodology have been described previously.12 To focus on participants with chronic illness, who may be forced to choose month after month between medications and food and for whom such tradeoffs may have important clinical consequences, we included adult participants (age ≥20 years) in the
Results
Our sample comprised 9696 adults who reported chronic illness. Overall, 23.4% of respondents, representing approximately 7.2 million Americans, reported cost-related medication underuse in the prior 12 months. In addition, 18.8% of respondents, representing 5.8 million American households, reported food insecurity. More than 11% of respondents reported both food insecurity and cost-related medication underuse. The baseline characteristics of our sample, stratified by the presence of
Discussion
In this nationally representative sample of adults with chronic disease, food insecurity and cost-related medication underuse were common, with 22% reporting food insecurity or cost-related medication underuse. Another 11% reported both food insecurity and cost-related medication underuse. The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is. These findings suggest
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Funding: SAB was supported by an Institutional National Research Service Award #T32HP10251, the Ryoichi Sasakawa Fellowship Fund, and by the General Medicine Division at Massachusetts General Hospital. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or preparation, review, decision to submit for publication, or approval of the manuscript.
Conflict of Interest: NKC has received unrestricted research grants from CVS Caremark, Aetna, the Commonwealth Fund, and the Robert Wood Johnson Foundation to study medication adherence. SAB and HKS report no conflicts of interest.
Authorship: SAB had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He also drafted the manuscript. HKS and NKC had access to the data and were critical in writing the manuscript.