A recent study published in JAMA network evaluated whether receipt of Supplemental Nutrition Assistance Program (SNAP) benefits can modify the consequences of food insecurity on nonadherence to antihypertensive medications.
Study: Supplemental Nutrition Assistance Program and Adherence to Antihypertensive Medications. Image Credit: Jonathan Weiss/Shutterstock.com
Background
Almost half of Americans today have high blood pressure, with about 1,000 deaths occurring daily as a consequence of this condition.
In fact, the American Heart Association estimates that hypertension in America costs the economy up to nearly $200 billion.
People with high blood pressure (BP) are at risk for multiple health conditions, both chronic and acute. These include uncontrolled blood pressure, cardiovascular events like stroke and heart attack, and an increased risk of death.
While blood pressure can be controlled by appropriate medication, the patient must adhere to the protocol and continue to take the medication for as long as required.
High BP is treated by modifying the diet, increasing physical activity, and reducing alcohol consumption. However, if these measures fail to control the BP, medications are begun. Non-adherence with antihypertensive medication is linked to adverse health outcomes and soaring healthcare costs.
Multiple factors contribute to noncompliance, such as patient perception of their condition and of the efficacy of drug treatment, lack of communication, poor healthcare access, financial stress, and coexisting depression or forgetfulness.
One of the modifiable factors for medication compliance is food insecurity, as people will prioritize food above medication if funds are limited.
The Supplemental Nutrition Assistance Program (SNAP) is America's largest social intervention program. It supplies vouchers to low-income families that can be exchanged towards buying food.
Its potential impact is estimated at as much as 16% reduction in poverty, or 8 million people. It also reduces the prevalence of food insecurity by up to 30%.
SNAP thus intervenes in two major risk factors for antihypertensive medication noncompliance. Recent research on diabetic patients showed a reduction in nonadherence to medication because of financial insecurity when SNAP benefits were received.
Therefore, The current study sought to understand its role in improving adherence to BP medications. The research aimed to assess whether the reduction in food insecurity with SNAP reflected in better adherence to antihypertensive medication.
What did the study show?
The study followed a retrospective cohort design with nearly 6,700 participants. The data came from the Medical Expenditure Panel Survey (MEPS)–National Health Interview Survey (NHIS) dataset for 2016 to 2017.
Participants were assessed for whether they had received SNAP benefits over the past year, and their food insecurity status over the past month. Self-reported use of prescription medication was employed to find the odds of antihypertensive medication use.
Of the participants, 13% had received SNAP benefits over the past year, and 15% were food insecure. The mean age of the participants was 63 years. Nearly 72% were White.
About 15% (one in seven) of the participants said they were food insecure during the past month, compared to over 40% of those who received SNAP benefits. In contrast, only 11% of non-recipients were food insecure.
About 56% of participants on BP medication were nonadherent. Overall, receipt of SNAP benefits was not associated with a significant difference in the use of antihypertensive medications.
Even so, nonadherence was reduced among those who used SNAP benefits 1-3 times a year than among nonrecipients.
Among those who used the program 4-6 or 7-9 times a year, compared to nonrecipients, nonadherence was higher overall and among the food-secure. Among the subgroup who used SNAP 10-12 times a year, nonadherence was lower by 11% among the food-insecure but not the food-secure.
When stratified by food insecurity, BP medication non-adherence was eight percentage points lower among those who used SNAP benefits than among non-users.
People experiencing food insecurity were less likely to stick to their anti-hypertensive medications while on SNAP compared to those who were food secure and on medication for high BP. The difference was 14 percentage points.
What are the implications?
The findings suggest that “patients with hypertension who receive SNAP benefits may be less likely to become nonadherent to antihypertensive medication, especially if they are experiencing food insecurity.”
This may point to the feasibility of using SNAP to promote greater compliance with antihypertensive medications. Future research should examine this possibility using prospective trials or natural experiments.
The study thus supports research on the utility of social intervention programs in modifying health outcomes. No prior study has looked at whether and how food insecurity modifies the association between SNAP and BP medication compliance.
However, a few studies demonstrated lower nonadherence because of medication costs involving all medications in use in older adults.
As SNAP may become restricted in its reach in the near future, the implications for national health should be examined in light of these findings.
“More individuals and families are likely to experience food insecurity and may be less likely to refill medications to treat chronic disease.”
As a logical step, therefore, SNAP should be extended to hypertensive patients to reduce adherence to medications, both for-cost-related and other reasons.
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