Financial hardship in chronically ill may lead to medication underuse

Chronically ill adults don’t have consistent access to food due to lack of financial stability were significantly more likely to report cost-related medication underuse, according to a new study published in The American Journal of Medicine. Cost-related medication underuse refers to taking less medication than prescribed, or not taking it at all because of financial concerns.

“Both food insecurity and cost-related medication underuse are very common in chronically-ill patients,” according to lead investigator Seth A. Berkowitz, MD, division of general internal medicine, Massachusetts General Hospital and Harvard Medical School. “We need to consider ways to address them as part of chronic disease management.”

Approximately one in three patients have trouble affording food, medication, or both, according to Dr. Berkowitz.

In order to explore the possible link between food insecurity and cost-related medication underuse, Dr. Berkowitz and colleagues looked at 9,696 adult participants in the National Health Interview Survey (NHIS) who had reported chronic illness. They found that 23.4% of the chronically ill study participants reported cost-related medication underuse, while 18.8% reported food insecurity, and 11% reported both.

The researchers also looked at ethnicity and found that participants with both medication underuse and food insecurity were more likely to be Hispanic or non-Hispanic black. They were also more likely to have several chronic conditions versus those participants who reported no food insecurity or medication underuse and a lack of insurance was more prevalent in groups with medication underuse.

“These problems are more common in racial/ethnic minority groups and those with lower educational attainment and income. Public policy programs, such as Medicaid and WIC [Women, Infants, and Children], are associated with reductions in both problems,” Dr. Berkowitz said. “Medicaid has a generous pharmacy benefit, and Medicaid beneficiaries, adjusted for many potential confounders, are less likely to report cost-related medication underuse and food insecurity, even though Medicaid doesn’t affect food insecurity directly.”

Similarly, WIC beneficiaries report lower food insecurity and lower cost-related medication underuse, even though WIC doesn’t target medications, Dr. Berkowitz explained. “Thus these programs may have important ‘spill-over’ effect,” he said.

“This is important because of how common it is, and because there may be policy solutions,” he continued. Policy solutions include ensuring that patients are enrolled in programs for which they are eligible, and include ways to address socioeconomic needs as part of a population management initiative.