Despite optimism about the economy in some quarters, many people in the U.S. as well as worldwide continue to feel financial strain. According to recent Pew Research Center survey, the proportion of Americans who identify with the middle class has never been lower, dropping to 44 percent while those who say they are in the lower or lower-middle classes rose to 40 percent over the past six years, an increase of 15 percentage points. Worse, one in five Americans reported having trouble meeting basic needs in other reports.

Now, a new study published today in the American Journal of Medicine adds to these painful truths. The researchers discovered that chronically ill adults who are financially unstable and lack consistent access to food are also more likely to not take their medicine.

Nationally Representative Survey

To explore a possible link between not having enough food and not taking medicine, a team of Harvard researchers reviewed 9,696 adults who had reported chronic illness while participating in the National Health Interview Survey (NHIS). Among these chronically ill participants, 23.4 percent reported medication underuse, 18.8 percent reported not having enough food, and 11 percent reported both. Based on these findings, the researchers estimated that one in three chronically ill NHIS participants are unable to afford food, medicine, or both. Looking more closely at the one-in-three subgroup, the researchers discovered they also were more likely to have several chronic conditions when compared to other participants, plus they were more likely to be Hispanic or non-Hispanic black.

"The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is," said Dr. Seth A. Berkowitz, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School.

Berkowitz, who led the study, believes these findings might guide health policy. Respondents who participated in Medicaid or the Woman, Infants, and Children (WIC) food and nutrition service, for instance, were less likely to report both food insecurity and medication underuse due to financial hardship.

Participants with incomes 100 to 200 percent above the Federal Poverty Line — and may not be eligible for government assistance — also reported high rates of food insecurity and cost-related medication underuse. "Low- or no-cost sharing prescription drug benefits have been associated with improved health outcomes in a general population, as well as the reduction of socioeconomic disparities in health outcomes," Berkowitz said in a press release.

For policy makers, food insecurity represents an easily identified risk factor for cost-related medication underuse, making it simpler to find programs and strategies to address this endangered group in a meaningful way. “Interventions targeted to under-resourced groups who may face 'treat or eat' choices could produce substantial health gains for these vulnerable patients," wrote Berkowitz in the conclusion of his published study.

Source: Berkowitz SA, Seligman HK, Choudhry NK. Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs, The American Journal of Medicine. 2014.