FOR PROFIT HEALTHCARE
Food insecurity doubled likelihood of foregoing or delaying medical care during first year of COVID-19 pandemic in U.S.
Survey conducted in December 2020 also found minorities and low-income individuals were at elevated risk of food insecurity
Peer-Reviewed PublicationIndividuals experiencing food insecurity—a household’s lack of consistent access to adequate food resources—in the U.S. during the first year of the pandemic were more than twice as likely to forego or delay medical care due to cost concerns compared to food-secure households, according to a survey led by researchers at the Johns Hopkins Bloomberg School of Public Health.
Conducted in December 2020, the survey also found that racial and ethnic minority groups and lower-income individuals were significantly more likely to face food insecurity compared to whites and higher-income individuals.
The findings were published online April 13 in the American Journal of Public Health.
For their study, the researchers conducted a nationally representative online survey of 8,481 adults aged 18 and older between December 15 and December 21, 2020. The researchers found that nearly one in five adults—18.8 percent—reported experiencing food insecurity at some point during the previous 30 days. Of those experiencing food insecurity, nearly 3 in 10 (27.4 percent) reported delaying or foregoing medical care in the last month.
In addition to delaying any medical care during the prior month, individuals with food insecurity were also two to three times more likely to have delayed or foregone specific types of care during the first nine months of the pandemic, including skipping a treatment or test recommended by a doctor, not going to a recommended follow-up visit, and not filling a prescription.
The link between food insecurity and foregoing medical treatment is well documented. This study is thought to be the first to investigate this relationship during the pandemic.
“We already know that people who struggle with maintaining a healthy diet are at higher risk of many health problems, including those that can make them more vulnerable to COVID-19,” says Jaclyn Bertoldo, MPH, RDN, the lead author of the study and a Bloomberg American Health Fellow and DrPH student at the Bloomberg School. “Delaying or postponing care could compound the risk of COVID-19 complications and contribute to widening health disparities in the pandemic and well after it ends.”
The researchers also found that food insecurity disproportionately affected racial and ethnic minority groups and low-income people. Non-Hispanic Blacks were nearly two times as likely as whites to face food insecurity, and Hispanics more than one and a half times as likely as whites. People who had lost a job or more than half of their income due to the pandemic were three and a half times more likely to experience food insecurity.
“Individuals experiencing food insecurity often make difficult tradeoffs between food and other basic needs, including health care,” says Julia Wolfson, PhD, co-lead author of the study and an assistant professor in the Department of International Health at the Bloomberg School. “Policies to help offset the cost of food, such as Supplemental Nutrition Assistance Benefits, or food stamps, are critical to provide food insecure households with needed money.”
The authors note that tying SNAP benefits to inflation and more frequently adjusting benefit levels is important to help low-income families afford the true cost of food. They also add that continuing to expand access to Medicaid and working toward more affordable health insurance and prescription drug prices can also help low-income families avoid needing to choose between health care and food.
This survey was part of the National Pandemic Pulse project, a series of comprehensive surveys led by researchers at the Johns Hopkins University. Begun in September 2020, the series’ surveys measure disparities and inequities in the experience and impact of the COVID-19 pandemic.
“Food insecurity and delayed or foregone medical care during the COVID-19 pandemic” was written by Jaclyn Bertoldo, Julia A. Wolfson, Samantha M. Sundermeir, Jeffrey Edwards, Dustin Gibson, Smisha Agarwal, and Alain Labrique.
The study was funded by the Johnson & Johnson Foundation through the National Pandemic Pulse project.
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JOURNAL
American Journal of Public Health
ARTICLE TITLE
Food insecurity and delayed or foregone medical care during the COVID-19 pandemic
ARTICLE PUBLICATION DATE
13-Apr-2022
Investigating the connections between medicaid and cancer survival
University of Colorado Cancer Center Deputy Director Cathy Bradley, PhD, recently published two papers on Medicaid-related research
Peer-Reviewed PublicationAt first blush, the numbers aren’t great: Cancer patients who are covered by Medicaid tend to have later-stage disease and higher rates of mortality.
But when Cathy Bradley, PhD, deputy director of the University of Colorado (CU) Cancer Center, started digging into the data a little deeper, she found some of the reasons for the dire statistics. Many people with cancer enroll in Medicaid only after they are diagnosed, suggesting they may have been uninsured prior to diagnosis and had limited access to cancer screening and treatment.
“What some researchers have done in the past is looked at Medicaid and observed that people who are insured by Medicaid and diagnosed with cancer have late-stage disease and greater mortality rates,” she says. “What I was able to show is that Medicaid is actually picking up people who were otherwise uninsured or underinsured. They get diagnosed with cancer, and enroll in Medicaid afterward. By then, they have late-stage cancer because they most likely did not have health insurance that would have given them access to screening and treatment prior to cancer diagnosis.”
In recent research published in the journal Cancer Epidemiology, Biomarkers & Prevention, Bradley also shows that cancer patients who were insured by Medicaid prior to diagnosis do about as well as people with private insurance.
“Ultimately, the message is that having continuous coverage in order to be able to get access to screening and care prevents late-stage disease and high mortality,” she says.
Insurance trumps income
Using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Cancer Registry, linked with Medicaid enrollment data, Bradley looked at the association between Medicaid enrollment and distant stage for three screening-amenable cancers: breast, cervical, and colorectal. In addition to her general findings about the importance of continuous insurance coverage, she looked specifically at the National Breast and Cervical Cancer Early Detection Program, a Centers for Disease Control initiative that offers free breast and cervical cancer screening to uninsured or underinsured low-income women who were not low-income enough to qualify for Medicaid initially.
“If cancer is found, these women are enrolled in their state Medicaid program, but Medicaid may only cover their cancer-related treatment rather than full coverage,” Bradley says. “Providers may also be reimbursed at a lower rate than regular Medicaid. What I was able to show is the breast and cervical cancer screening program — which has saved thousands of lives — is inferior to having continuous insurance coverage. Because these women, even though they were slightly higher income, it wasn't the income that made a difference. It was the health insurance.”
Call for coverage
Not surprisingly, Bradley’s paper concludes with a call for more insurance options for those with lower incomes. The Affordable Care Act, which went into effect in 2014, expanded Medicaid eligibility, but many states opted not to expand, setting their income thresholds much lower than the federal guidelines allow.
“Medicaid has gotten an undeserved bad rap. I’m certain Medicaid would rather have patients prior to diagnosis or early stage and take care of them rather than spend a whole lot of money and have them die,” Bradley says. “Even though states that expanded Medicaid greatly reduced the number of uninsured people, there are still over 12 million uninsured people who do not qualify for Medicaid and still don’t have health insurance. And those are the ones most vulnerable to late-stage diagnosis.”
The HIV-cancer connection
An economist by training, Bradley has a longtime interest in insurance and Medicaid and how they affect those diagnosed with cancer. In “An ounce of prevention: Medicaid's role in reducing the burden of cancer in men with HIV,” a recent editorial in the journal Cancer, she explains how people living with HIV have a greater incident of some cancers. Thanks to new treatments, many of these people are expected to live long-term and will require treatment for cancer, she says, and because many of them are also insured by Medicaid, new approaches to public health practice and policy are needed.
“Cancer drugs can be super-expensive, and we've got to think about this complex care of providing for people with both conditions, when 20-30 years ago, you would have died from either of them,” she says. “Now both become chronic, and the cost of the drugs for both conditions is very expensive.”
To avoid these costs, she says, greater emphasis on prevention through HPV vaccination and screening is needed. Measures to control drug costs will also be needed as the population grows.
JOURNAL
Cancer Epidemiology Biomarkers & Prevention
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