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Many chronically ill Americans unable to afford food, medicine

By Allison Bond

NEW YORK (Reuters Health) - One in three Americans with a chronic disease such as diabetes, arthritis or high blood pressure has difficulty paying for food, medications or both, according to a new study.

People who had trouble affording food were four times more likely to skip some of their medications due to cost than those who got plenty to eat, researchers found.

"This leads to an obvious tension between 'milk' or 'med,'" said Dr. Niteesh Choudhry, who worked on the study at Brigham and Women's Hospital in Boston. "If you have a fixed income, should you treat or should you eat?"

The findings are based on data collected by the 2011 National Health Interview Survey, a questionnaire that offers a snapshot of the U.S. population as a whole. Nearly 10,000 people age 20 and up filled out the survey and reported having one or more chronic illnesses like cancer, asthma, emphysema or a psychiatric illness.

Among those participants, 23 percent took their medication less often than prescribed because of the cost, 19 percent reported difficulty affording food and 11 percent said they were having trouble paying for both food and medications. In the end, about one in three had trouble affording food, medication or both.

These rates are high but are similar to figures found in previous studies, said lead author Dr. Seth Berkowitz, from Massachusetts General Hospital in Boston.

Yet the link between difficulty paying for food and for medications is a novel one.

"The idea of tradeoffs that people might make (between buying medications or food) is something we haven't seen before," said Berkowitz.

The researchers also found that patients who had difficulty paying for both food and meds were 58 percent more likely to be Hispanic or African American.

With each additional chronic illness the patients reported, their risk of having a tough time affording those items went up by 56 percent, according to the findings published in The American Journal of Medicine.

Finally, people having trouble affording medications and food were 30 percent less likely to have public, non-Medicare insurance like Medicaid, and about 60 percent less likely to participate in the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC. This program provides supplemental food and healthcare referrals for certain women and children up to age five.

By removing some of the financial pressure from people struggling to afford food, assistance programs like WIC may also help them afford their medications, Berkowitz said.

For that reason, for people struggling to pay for either food or medications, the authors recommend looking into eligibility for food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and WIC, along with community support services like food banks.

When it comes to medications, there may be cheaper alternatives or assistance programs for the medication a patient is already taking.

"The most important thing people can do is talk with their doctors about it," said Berkowitz.

It's also important for people to be honest with their doctor if they are unable to afford enough food, since that may affect which medications and dosages are best.

"If you are eating very irregularly, a medication that might be perfectly safe when you are eating regularly could cause low blood sugar," or other complications, Berkowitz told Reuters Health.

If patients don't bring up the fact that they are struggling to afford medications or food, Berkowitz said, the doctor won't know to adjust medications accordingly.

He said people should "not be embarrassed or ashamed" to bring up the topic with their doctor.

SOURCE: bit.ly/1evzX7V The American Journal of Medicine, online January 21, 2014.

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