FOOD INSECURITY AND ANTIHYPERTENSIVE MEDICATION ADHERENCE AMONG ADULTS WITH HYPERTENSION: A REAL-WORLD STUDY
Author(s)
Amy M. Austin, MHI, Ekaterina A. Khlystova, PhD, Claire Edwards Campbell, PhD, Sarah Eng, MPH, Jeffrey Ratto, PhD, Katherine Kendrick, MPH, Sunny Guin, PhD, Vidya Venkataraman, MPH, PhD.
Truveta, Bellevue, WA, USA.
Truveta, Bellevue, WA, USA.
OBJECTIVES: Examine the association between individual-level food insecurity screening results and antihypertensive medication adherence among adults with hypertension.
METHODS: This retrospective cohort study used de-identified electronic health record (EHR) data from Truveta, sourced from U.S. health systems. Index food insecurity screening dates spanned January 2022 to April 2025, with 12-month follow-up extending through April 2026. Adults with diagnosis of hypertension, an active antihypertensive prescription, and a documented food insecurity screen were included. Food insecurity status was classified using the Hunger Vital Sign (HVS) supplemented by the U.S. Food Security Survey (USFSS). Antihypertensive adherence was measured using proportion of days covered (PDC) across eight drug classes during the 12 months following the index screening date. Adherence was defined as PDC ≥0.80. Multivariable logistic regression estimated adjusted odds ratios (aORs) adjusting for age, sex, race/ethnicity, region, baseline SBP, and nine comorbidities. Chi-square tests assessed unadjusted group differences.
RESULTS: Among 333,182 adults with hypertension and documented food insecurity screening, 227,500 (68.3%) screened positive and 105,682 (31.7%) screened negative. Screen-positive patients had lower adherence than screen-negative patients (78.4% vs 80.2%; p<0.0001) even after adjustment (aOR=0.922; 95% CI: 0.901-0.943; p<0.0001). Screen-positive patients were more likely to experience a 30-day medication gap (24.7% vs 22.7%; p<0.0001) and a 90-day gap (7.3% vs 6.5%; p<0.0001). Baseline SBP was similar between groups (134.1 mmHg), but 12-month BP control (SBP <130 mmHg) was lower among screen-positive patients (47.7% vs 49.4%; p<0.0001).
CONCLUSIONS: Food insecurity was independently associated with lower antihypertensive medication adherence and poorer blood pressure control. Associations varied by region and instrument severity, suggesting context-dependent barriers. These findings support incorporating social needs screening into hypertension management and addressing food insecurity within cardiovascular risk reduction strategies.
METHODS: This retrospective cohort study used de-identified electronic health record (EHR) data from Truveta, sourced from U.S. health systems. Index food insecurity screening dates spanned January 2022 to April 2025, with 12-month follow-up extending through April 2026. Adults with diagnosis of hypertension, an active antihypertensive prescription, and a documented food insecurity screen were included. Food insecurity status was classified using the Hunger Vital Sign (HVS) supplemented by the U.S. Food Security Survey (USFSS). Antihypertensive adherence was measured using proportion of days covered (PDC) across eight drug classes during the 12 months following the index screening date. Adherence was defined as PDC ≥0.80. Multivariable logistic regression estimated adjusted odds ratios (aORs) adjusting for age, sex, race/ethnicity, region, baseline SBP, and nine comorbidities. Chi-square tests assessed unadjusted group differences.
RESULTS: Among 333,182 adults with hypertension and documented food insecurity screening, 227,500 (68.3%) screened positive and 105,682 (31.7%) screened negative. Screen-positive patients had lower adherence than screen-negative patients (78.4% vs 80.2%; p<0.0001) even after adjustment (aOR=0.922; 95% CI: 0.901-0.943; p<0.0001). Screen-positive patients were more likely to experience a 30-day medication gap (24.7% vs 22.7%; p<0.0001) and a 90-day gap (7.3% vs 6.5%; p<0.0001). Baseline SBP was similar between groups (134.1 mmHg), but 12-month BP control (SBP <130 mmHg) was lower among screen-positive patients (47.7% vs 49.4%; p<0.0001).
CONCLUSIONS: Food insecurity was independently associated with lower antihypertensive medication adherence and poorer blood pressure control. Associations varied by region and instrument severity, suggesting context-dependent barriers. These findings support incorporating social needs screening into hypertension management and addressing food insecurity within cardiovascular risk reduction strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR106
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas