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Health Serv Res. 2018 Jun;53(3):1600-1620. doi: 10.1111/1475-6773.12730. Epub 2017 Jun 13.

Food Insecurity and Health Care Expenditures in the United States, 2011-2013.

Author information

1
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
2
Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA.
3
Harvard Medical School, Boston, MA.
4
Department of Medicine, Stanford University, Palo Alto, CA.
5
Center for Primary Care, Harvard Medical School, Boston, MA.
6
Division of General Internal Medicine, University of California San Francisco, San Francisco, CA.
7
Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital & Trauma Center, San Francisco, CA.

Abstract

OBJECTIVE:

To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures.

DATA SOURCE/STUDY SETTING:

Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]).

STUDY DESIGN:

Longitudinal retrospective cohort.

DATA COLLECTION/EXTRACTION METHODS:

A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area.

PRINCIPAL FINDINGS:

Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually.

CONCLUSIONS:

Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs.

KEYWORDS:

Food insecurity; cardiovascular disease; diabetes, cardiovascular disease; health expenditures; hypertension; socioeconomic status

PMID:
28608473
PMCID:
PMC5980147
DOI:
10.1111/1475-6773.12730

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