Men Fei, Gundersen Craig, Urquia Marcelo L, Tarasuk Valerie
Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont.
CMAJ Open. 2019 Sep 23;7(3):E590-E597. doi: 10.9778/cmajo.20190075. Print 2019 Jul-Sep.
Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada.
Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics.
Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence ( > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence ( < 0.01 for both).
Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.
粮食不安全被定义为因经济限制而无法获得足够的食物，它与疾病管理不善有关。由于与费用相关的处方药不依从可能是这种关联的一个解释，我们研究了加拿大粮食不安全与与费用相关的药物不依从之间的联系。
利用参与2016年加拿大社区健康调查关于处方药使用的快速反应模块的成年受访者（年龄≥18岁）的数据，我们评估了家庭粮食不安全与过去12个月中与费用相关的处方药不依从之间的关联。我们进一步研究了不依从者中与费用相关的不依从对自我感知健康的影响。我们应用了带有自抽样权重的泊松模型，对社会人口学特征进行了调整。
在我们样本中的11172名受访者中，930人（8.3%）报告了与费用相关的不依从。粮食不安全影响了10.5%（95%置信区间[CI]9.1%至11.8%）的依从者和47.9%（95%CI 38.1%至57.7%）的不依从者。在对混杂因素进行调整后，中度和重度粮食不安全与费用相关不依从的患病率分别比粮食安全者高3.83倍（95%CI 2.44至6.03）和5.05倍（95%CI 3.27至7.81）。尽管拥有药物保险与费用相关不依从的可能性较低有关，但它并没有改变粮食不安全与费用相关不依从之间的关系（所有交互作用的P>0.1）。严重粮食不安全与健康恶化的患病率较高以及作为与费用相关不依从的感知后果而更多地使用医疗服务相关（两者的P<0.01）。
加拿大粮食不安全的成年人比粮食安全的成年人更有可能出现与费用相关的处方药不依从，这可能对他们的健康构成负担，并导致更多地使用医疗服务。
