Abstract Body (Do not enter title and authors here): Background
The association of cost-related medication non-adherence (CRN) with food insecurity (FI) is not well described in those with atherosclerotic cardiovascular disease (ASCVD).
Research Questions
Is FI associated with CRN in those with ASCVD, and does enrollment in the Supplemental Nutrition Assistance Program (SNAP) modify this effect?
Methods
Data from the National Health Interview Survey (NHIS) 2011-2018 cycles were analyzed. A total of 22,304 adults (weighted: 17.7 million) with ASCVD and available food security, medication adherence and linked mortality data from the National Death Index were included. FI was defined as 3 or more affirmative responses to the USDA food security survey. CRN was identified by an affirmative response to delayed prescription filling, took less medication, or skipped medication doses to save money in the past 12 months. Analyses accounted for the complex survey design to obtain nationally representative estimates. Survey-weighted logistic regression was used to determine predictors of CRN, and Cox regression was used for mortality analyses.
Results
Among adults with ASCVD, 13.3% (95% CI 12.7-13.9%; 2.34 million) reported CRN, 15.0% (95% CI 14.3-15.7%; 2.65 million) reported FI, and 5.7% (95% CI 5.3-6.2%; 1.01 million) reported both concomitantly. Those reporting CRN were more likely to be younger, female, non-white, without health insurance, below the federal poverty limit, have lower educational attainment, more comorbidities, and report FI. FI and SNAP enrollment were significantly associated with CRN after multivariable adjustment (adjusted odds ratio [aOR] 4.35 [95% CI 3.74-5.05] and 1.28 [95% CI 1.06-1.55], respectively). A significant interaction was observed between FI and SNAP enrollment (Pint = 0.001), and FI was associated with lower odds of CRN among the SNAP-enrolled versus unenrolled (aOR 2.50 [95% CI 1.98-3.14] vs 5.74 [95% CI 4.82-6.85]) (Figure 1). CRN and food security were not significant predictors of all-cause or cardiovascular mortality in the fully adjusted models.
Conclusion
Among adults with ASCVD, FI and SNAP enrollment independently predict CRN. Among adults with ASCVD and FI, more than one third reported CRN and those without SNAP had more than twice the odds of CRN. Greater SNAP enrollment may improve medication adherence in those with ASCVD and FI.