A recent study published in JAMA network evaluated whether receipt of Supplemental Nutrition Assistance Program (SNAP) benefits can modify the effects of food insecurity on antihypertensive medication nonadherence.
Study: Supplemental Nutrition Assistance Program and Antihypertensive Medication Adherence. Image credit: Jonathan Weiss/Shutterstock.com
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Nearly half of Americans today have high blood pressure, with about 1,000 deaths occurring each day as a result of the condition.
In fact, the American Heart Association estimates that hypertension in America costs the economy 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 such as stroke and heart attack, and an increased risk of death.
While blood pressure can be controlled with appropriate medication, the patient must adhere to the protocol and continue taking the medication for as long as needed.
High BP is treated by modifying diet, increasing physical activity, and reducing alcohol consumption. However, if these measures fail to control BP, medications are started. Nonadherence to antihypertensive medication is associated with adverse health outcomes and increased health care costs.
Many factors contribute to nonadherence, including patients’ perception of their condition and the effectiveness of medication, lack of communication, poor access to health care, financial stress, and co-occurring depression or forgetfulness.
One of the modifiable factors for medication adherence is food insecurity, as people will prioritize food over medication if money is limited.
The Supplemental Nutrition Assistance Program (SNAP) is America’s largest social intervention program. Provides vouchers to low-income families that can be redeemed to purchase food.
Its potential impact is estimated to reduce poverty by up to 16%, 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 nonadherence. Recent research in diabetic patients showed a reduction in medication nonadherence due to financial insecurity when SNAP benefits were received.
Therefore, the present study sought to understand its role in improving blood pressure medication adherence. The research aimed to assess whether the reduction in food insecurity with SNAP is reflected in better adherence to antihypertensive medications.
What did the study show?
The study followed a retrospective cohort design with nearly 6,700 participants. Data are from the 2016 to 2017 Medical Expenditure Survey (MEPS)–National Health Interview Survey (NHIS) dataset.
Participants were assessed on whether they had received SNAP benefits in the past year and their food insecurity status in the past month. Self-reported prescription drug use was used to find odds of antihypertensive drug use.
Of the participants, 13% had received SNAP benefits in the past year and 15% were food insecure. The average age of the participants was 63 years. Almost 72% were White.
About 15% (one in seven) of participants said they were food insecure in the past month, compared to more than 40% of those receiving SNAP benefits. In contrast, only 11% of those not accepted were food insecure.
About 56% of participants taking blood pressure medication were nonadherent. Overall, receipt of SNAP benefits was not associated with a significant difference in antihypertensive medication use.
Even so, nonadherence was reduced among those who used SNAP benefits 1-3 times a year relative to nonrecipients.
Among those using the program 4-6 or 7-9 times per year, compared with non-recipients, non-adherence was higher overall and among safe eaters. Among the subgroup who used SNAP 10-12 times a year, nonadherence was 11% lower among the food insecure but not the food secure.
When categorized by food insecurity, blood pressure medication nonadherence was eight percentage points lower among those who used SNAP benefits than among nonusers.
People who were food insecure were less likely to stay on their blood pressure medication while taking SNAP compared to those who were food secure and taking high BP medication. The difference was 14 percentage points.
What are the consequences;
The findings suggest that “hypertensive patients receiving SNAP benefits may be less likely to be nonadherent to antihypertensive therapy, especially if they experience food insecurity.”
This may suggest the feasibility of using SNAP to promote greater adherence to antihypertensive medications. Future research should examine this possibility using prospective trials or natural experiments.
The study therefore supports research on the utility of social intervention programs in modifying health outcomes. No previous study has examined whether and how food insecurity modifies the association between SNAP medication adherence and BP.
However, some studies have shown lower nonadherence due to medication costs for all medications used in older adults.
As SNAP may be limited in its reach in the near future, national health implications should be considered 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 conditions.”
As a logical step, therefore, SNAP should be extended to hypertensive patients to reduce medication adherence, both for cost and other reasons.
