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

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• 作者：Seth A. Berkowitz ; MD^a ; ^b ; ^{SABerkowitz@partners.org" class="auth_mail} ; Hilary K. Seligman ; MD ; MAS^c ; Niteesh K. Choudhry ; MD ; PhD^b ; ^d
• 关键词：Chronic disease ; Medication adherence ; Socioeconomic factors ; Population health ; Underserved populations
• 刊名：The American Journal of Medicine
• 出版年：April, 2014
• 年：2014
• 卷：127
• 期：4
• 页码：303-310.e3
• 全文大小：193 K

文摘

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 鈥減sychiatric problem鈥? aged 鈮?0 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.