Participation in the Supplemental Nutrition Assistance Program (SNAP) may reduce the number of low-income older adults with diabetes forgoing medications because of cost, according to a study published online Nov. 19 in JAMA Internal Medicine.

Jennifer A. Pooler, M.P.P., and Mithuna Srinivasan, Ph.D., from IMPAQ International in Columbia, Maryland, evaluated data from 1,302 seniors who participated in the National Health Interview Survey from 2013 through 2016.

Included participants had diabetes or borderline diabetes was eligible to receive SNAP benefits, was prescribed medications, and incurred out-of-pocket medical expenses in the previous year.

The researchers found that 36.3% of the study participants participated in SNAP and 12.9% reported cost-related medication nonadherence in the previous year. There was a moderate decrease in cost-related medication nonadherence among participants in SNAP compared with eligible nonparticipants.

Similar results were seen for subgroups that had prescription drug coverage and less than $500 in out-of-pocket medical costs in the previous year; however, similar reductions were not seen not for older adults lacking prescription coverage or those with higher medical costs.

"In addition to alleviating food insecurity, food assistance programs such as the Supplemental Nutrition Assistance Program may have a spillover income benefit by helping older adults with diabetes better afford their medications, perhaps by reducing out-of-pocket food expenditures," the authors write.

Supplemental Nutrition Assistance Program

To examine whether participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with a reduced likelihood of low-income older adults with diabetes (aged ≥65 years) needing to forgo medications because of cost.

This repeated cross-sectional, population-based study included 1302 seniors who participated in the National Health Interview Survey from 2013 through 2016. Individuals in the study were diagnosed with diabetes or borderline diabetes were eligible to receive SNAP benefits, were prescribed medications, and incurred more than zero US dollars in out-of-pocket medical expenses in the past year. The data analysis was performed from October 2017 to April 2018.

Cost-related medication nonadherence derived from responses to whether in the past year, older adults with diabetes delayed refilling a prescription, took less medication, and skipped medication doses because of cost.

To estimate the association between participation in SNAP and cost-related medication nonadherence, we used 2-stage, regression-adjusted propensity score matching, conditional on sociodemographic and health and health care–related characteristics of individuals.

Estimated propensity scores were used to create matched groups of participants in SNAP and eligible nonparticipants. After matching, a fully adjusted weighted model that included all covariates plus food security status was used to estimate the association between SNAP and cost-related medication nonadherence in the matched sample.

The final analytic sample before matching included 1385 older adults (448 [32.3%] men, 769 [55.5%] non-Hispanic white, and 628 [45.3%] aged ≥75 years), with 503 of them participating in SNAP (36.3%) and 178 reporting cost-related medication nonadherence (12.9%) in the past year.

After matching, 1302 older adults were retained (434 [33.3%] men, 716 [55.0%] non-Hispanic white, and 581 [44.6%] aged ≥75 years); treatment and comparison groups were similar for all characteristics.

Participants in SNAP had a moderate decrease in cost-related medication nonadherence compared with eligible nonparticipants (5.3% point reduction; 95% CI, 0.5-10.0% point reduction; P = 0.03).

Similar reductions were observed for subgroups that had prescription drug coverage (5.8% point reduction; 95% CI, 0.6-11.0) and less than $500 in out-of-pocket medical costs in the previous year (6.4% point reduction; 95% CI, 0.8-11.9), but not for older adults lacking prescription coverage or those with higher medical costs. Results remained robust to several sensitivity analyses.

The findings suggest that participation in SNAP may help improve adherence to treatment regimens among older adults with diabetes. Connecting these individuals with SNAP may be a feasible strategy for improving health outcomes.