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Food Insecurity, Dietary Quality, and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study

      Abstract

      Background

      Food insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities.

      Objective

      Our aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults.

      Design

      This was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey.

      Participants/setting

      Participants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States.

      Main outcome measures

      Self-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization.

      Statistical analyses

      Multiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality.

      Results

      In a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44).

      Conclusions

      Adults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.

      Keywords

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      Biography

      J. Jia is a clinical and research fellow, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.

      Biography

      V. Fung is an assistant professor of medicine, Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA.

      Biography

      J. B. Meigs is a professor of medicine, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.

      Biography

      A. N. Thorndike is an associate professor of medicine, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, and Harvard Medical School, Harvard University, Boston, MA.