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

https://doi.org/10.1016/j.amjmed.2014.01.002Get rights and content

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.

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.

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