Treat or eat: food insecurity, cost-related medication underuse, and unmet needs.
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.
General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address: SABerkowitz@partners.org.
Seth A
SA
Berkowitz
Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, University of California San Francisco.
Hilary K
HK
Seligman
Department of Medicine, Harvard Medical School, Boston, Mass; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Niteesh K
NK
Choudhry
D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000191:economics* / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D016903:Drug Monitoring
Chronic disease; Medication adherence; Population health; Socioeconomic factors; Underserved populations