College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, Arizona 85004.
Harry S Truman School of Public Affairs, University of Missouri, 239 Middlebush Hall, Columbia, Missouri 65211.
Am J Hypertens. 2023 Aug 5;36(9):485-490. doi: 10.1093/ajh/hpad052.
Black people are more likely to be diagnosed with hypertension and to experience food insecurity and antihypertensive medication non-adherence compared to White people in the U.S. The Supplemental Nutrition Assistance Program (SNAP)-a means-tested program that targets food insecurity has been shown to affect health outcomes. This study analyzed the relationship between SNAP participation and antihypertensive medication adherence among older Black Medicaid-insured individuals.
This is a retrospective cohort study using linked 2006-2014 state of Missouri Medicaid and SNAP administrative claims data. Analyses were restricted to older (≥60 years) Black individuals who were continuously enrolled in Medicaid for 12 months following their first observed claim for hypertension at or after age 60 years with at least one pharmacy claim (n = 10,693). Our outcome measure is a dichotomous measure of antihypertensive medication adherence defined using the Proportion of Days Covered (≥80% PDC = 1). The exposure variables are four measures of SNAP participation.
A higher proportion of SNAP participants were adherent to their antihypertensive medications compared to non-SNAP participants (43.5% vs. 32.0%). On multivariable analyses, compared to non-SNAP participants there was an increased likelihood of antihypertensive medication adherence among SNAP participants (prevalence ratio [PR] = 1.25; 95% confidence interval [CI] = 1.16-1.35). Compared to those who participated in SNAP for 1-3 months during the 12-month continuous enrollment, there was an increased likelihood of antihypertensive medication adherence among those who were enrolled for 10-12 months (PR = 1.41; 95% CI = 1.08-1.85).
Medicaid-insured older Black adults who were SNAP participants had a higher likelihood of antihypertensive medication adherence compared to non-SNAP participants.
与美国的白人相比，黑人更有可能被诊断出患有高血压，并且更有可能经历食品不安全和不遵守抗高血压药物治疗。补充营养援助计划（SNAP）是一个针对食品不安全问题的以需求为基础的项目，已经证明它可以影响健康结果。本研究分析了 SNAP 参与度与老年黑人医疗保险参保者抗高血压药物治疗依从性之间的关系。
这是一项使用密苏里州 2006-2014 年医疗保险和 SNAP 行政索赔数据进行的回顾性队列研究。分析仅限于≥60 岁的黑人，他们在年满 60 岁后首次观察到高血压索赔后，在接下来的 12 个月内持续参加医疗保险，并且至少有一次药房索赔（n=10693）。我们的结局衡量标准是使用覆盖比例（≥80%PDC=1）定义的抗高血压药物治疗依从性的二分变量。暴露变量是 SNAP 参与度的四项衡量标准。
与非 SNAP 参与者相比，更多的 SNAP 参与者对抗高血压药物的治疗依从性更高（43.5%比 32.0%）。在多变量分析中，与非 SNAP 参与者相比，SNAP 参与者抗高血压药物治疗依从性的可能性更高（患病率比[PR]=1.25；95%置信区间[CI]=1.16-1.35）。与在连续 12 个月注册期间仅参加 SNAP 1-3 个月的参与者相比，参加 SNAP 10-12 个月的参与者抗高血压药物治疗依从性的可能性更高（PR=1.41；95%CI=1.08-1.85）。
与非 SNAP 参与者相比，参加 SNAP 的医疗保险参保的老年黑人成年人更有可能遵守抗高血压药物治疗。
