URBANA, Ill. – Food insecurity is linked to higher disease rates but not much is known about the reasons for this. A new study of more than 10,000 Canadian households shows that this connection may be at least partially attributed to lack of access to prescription medication. 

“We knew that negative health outcomes are associated with food insecurity. But we didn’t really understand the mechanism,” says Craig Gundersen, distinguished professor of agricultural and consumer economics in the College of Agricultural, Consumer and Environmental Sciences at the University of Illinois.

This study indicates that people may become ill or get worse because they can’t afford their medications. “For example, we know that there is a close connection between food insecurity and diabetes; it could be the case that part of the reason is medication nonadherence,” he says.

Gundersen is co-author of the study, which draws on data from the Canadian Community Health Survey, conducted annually by the Canadian national statistics office.

The study included data from 11,172 respondents, combining information on food insecurity with prescription drug use. Overall, food insecurity affects 12.6% of Canadian households, and 8.5% of respondents reported some form of nonadherence to prescription drugs. Nonadherence includes skipping or reducing doses of medication, as well as delaying or not filling prescriptions because of cost.

The study showed a strong correlation between food insecurity and prescription drug nonadherence. Almost half (47.9%) of those who did not adhere to their prescription drug usage also reported some level of food insecurity. Of those who did adhere to their medications, only 10.5% were food insecure.

Results also indicated that nonadherence increases as food insecurity status gets worse. While just 4.9% of food secure households reported nonadherence to prescription drugs, cost-related nonadherence was reported by 13.2% of marginally, 29.4% of moderately, and by 47.1% of severely food insecure households.

Gundersen says that even though the health care system in Canada differs from the United States, there are lessons to learn for Americans in the study. All Canadians have access to health care; however, prescription drugs are covered by a combination of private and public insurance. Over four million Canadians are not enrolled in any drug insurance program.

“The study helps separate the effects of access to medical care from access to prescription drugs,” Gundersen says. “Even if health insurance is covered, people still face struggles if prescription drugs are not covered. This amplifies the conclusion that illness associated with food insecurity is related to lack of access to medication.”

Consequently, efforts to reduce food insecurity could lead to reductions in prescription drug nonadherence in both Canada and the United States, Gundersen concludes.

The article, “Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study” is published in CMAJ Open. [doi: 10.9778/cmajo.20190075]

Authors include Gundersen; Fei Men and Valerie Tarasuk, University of Toronto; and Marcelo L. Urquia, University of Manitoba. Funding was provided by a Canadian Institutes of Health Research grant.