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.
Article info
Publication history
Published online: July 08, 2021
Accepted:
June 1,
2021
Received:
September 21,
2020
Footnotes
Supplementary materials: Tables 2, 3, 4 and 5 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT J. Jia completed the study and manuscript under training grant no. T32HP32715 from the Health Resources and Services Administration.
AUTHOR CONTRIBUTIONS J. Jia and A. N. Thorndike conceived the study idea and design. J. Jia conducted the data analysis and drafted the manuscript. A. N. Thorndike, V. Fung, and J. B. Meigs advised on data analysis and provided critical revisions to the manuscript. All authors approved the final version.
Identification
Copyright
© 2021 by the Academy of Nutrition and Dietetics.
