• Seth A Berkowitz, Hilary K Seligman, James B Meigs, and Sanjay Basu.
• Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital/Harvard Medical School, 50 Staniford St, 9th Fl, Boston, MA 02114. Email: SABerkowitz@partners.org.
• Am J Manag Care. 2018 Sep 1; 24 (9): 399404399-404.

ObjectivesReducing utilization of high-cost healthcare services is a common population health goal. Food insecurity-limited access to nutritious food owing to cost-is associated with chronic disease, but its relationship with healthcare utilization is understudied. We tested whether food insecurity is associated with increased emergency department (ED) visits, hospitalizations, and related costs.Study DesignRetrospective analysis of a nationally representative cohort.MethodsAdults (≥18 years) completed a food insecurity assessment (using 10 items derived from the US Department of Agriculture Household Food Security Module) in the 2011 National Health Interview Survey and were followed in the 2012-2013 Medical Expenditures Panel Survey. Outcome measures were ED visits, hospitalizations, days hospitalized, and whether participants were in the top 10%, 5%, or 2% of total healthcare expenditures.ResultsOf 11,781 participants, 2056 (weighted percentage, 13.2%) were in food-insecure households. Food insecurity was associated with significantly more ED visits (incidence rate ratio [IRR], 1.47; 95% CI, 1.12-1.93), hospitalizations (IRR, 1.47; 95% CI, 1.14-1.88), and days hospitalized (IRR, 1.54; 95% CI, 1.06-2.24) after adjustment for demographics, education, income, health insurance, region, and rural residence. Food insecurity was also associated with increased odds of being in the top 10% (odds ratio [OR], 1.73; 95% CI, 1.31-2.27), 5% (OR, 2.53; 95% CI, 1.51-3.37), or 2% (OR, 1.95; 95% CI, 1.09-3.49) of healthcare expenditures.ConclusionsFood insecurity is associated with higher healthcare use and costs, even accounting for other socioeconomic factors. Whether food insecurity interventions improve healthcare utilization and cost should be tested.

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