Aim <p>Understanding socioeconomic factors related to unmet medical needs is essential to upgrade healthcare access, especially for individuals with higher healthcare requirements. This study aims to examine the socioeconomic factors associated with unmet medication needs among older adults across 60 countries.</p> Subject and methods <p>We analyzed cross-sectional data from 11,396 participants (49% male and 51% female) aged 65 and older. Data were examined using descriptive statistics and multivariable regression techniques. Descriptive statistics indicated the percentage of individuals with unmet medication needs.</p> Results <p>Overall, 10.3% of participants reported occasionally going without necessary medication, and 4.5% reported frequently going without care. Zimbabwe (36.4%) had the highest percentage of participants reporting frequent medication lapses, while Singapore had the highest percentage in the “never” category (88.8%). The results also showed that occasional food insecurity was associated with decreased odds of unmet needs: sometimes (OR 0.71), rarely (OR 0.44), and never (OR 0.08). Perceiving neighborhoods as “not very secure” (OR 1.79) and “not at all secure” (OR 1.97) increased the likelihood of unmet needs.</p> Conclusion <p>The findings reveal significant country-level disparities in unmet medication needs. Factors such as food insecurity, neighborhood safety, employment status, lower income, working-class status, and insecure neighborhoods are linked to higher odds of unmet needs; however, occasional food insecurity and higher income are associated with lower odds of unmet needs. These findings underscore the importance of addressing socioeconomic disparities and enhancing healthcare access to reduce unmet medication needs and improve health outcomes.</p>