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Pediatrics. 2019 Oct;144(4). pii: e20190347. doi: 10.1542/peds.2019-0347. Epub 2019 Sep 9.

Food Insecurity and Health Care Use.

Author information

Department of Population Medicine and Center for Healthcare Research in Pediatrics, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.
Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.



Fifteen percent of US children live in households with inadequate food. Children who are food insecure often experience worse physical, emotional, and developmental health outcomes. Authors of previous studies have not examined the quality and cost implications of food insecurity in children.


This is a retrospective study of 7959 nationally representative US children (aged 1-17 years) in the 2016 Medical Expenditure Panel Survey. Households with food insecurity were identified by ≥3 positive responses to the 30-day, 10-item US Food Security Survey. Main outcomes were annual health expenditures and quality of care indicators: emergency department (ED) and inpatient use, primary care and specialist visits, routine medical and dental care, patient experience measures, and school absenteeism. Logistic and 2-part regression models were constructed to estimate outcomes conditional on sociodemographic and medical covariates.


Children in households with food insecurity were more often publicly insured and had special needs compared with all other children. In multivariable logistic regression, household food insecurity was associated with significantly higher adjusted odds of an ED (adjusted odds ratio [aOR] = 1.37) or primary care treatment visit (aOR = 1.24) during the year. Household food insecurity was associated with significantly higher school absenteeism (aOR = 1.74) and lower access to care for routine (aOR = 0.55) or illness (aOR = 0.57) care. There were no differences in annual health expenditures, hospitalizations, or receipt of routine medical or dental care.


Household food insecurity is associated with higher ED use and school absenteeism and lower access to care; however, it was not associated with higher annual health expenditures in children.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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