Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 11:16:E90.
doi: 10.5888/pcd16.180549.

State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity

Seth A Berkowitz  1   2   3 , Sanjay Basu  4   5   6 , Craig Gundersen  7 , Hilary K Seligman  8   9
Affiliations

State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity

Seth A Berkowitz et al. Prev Chronic Dis. .

Abstract

Introduction: Food insecurity, or uncertain access to food because of limited financial resources, is associated with higher health care expenditures. However, both food insecurity prevalence and health care spending vary widely in the United States. To inform public policy, we estimated state-level and county-level health care expenditures associated with food insecurity.

Methods: We used linked 2011-2013 National Health Interview Survey/Medical Expenditure Panel Survey data (NHIS/MEPS) data to estimate average health care costs associated with food insecurity, Map the Meal Gap data to estimate state-level and county-level food insecurity prevalence (current though 2016), and Dartmouth Atlas of Health Care data to account for local variation in health care prices and intensity of use. We used targeted maximum likelihood estimation to estimate health care costs associated with food insecurity, separately for adults and children, adjusting for sociodemographic characteristics.

Results: Among NHIS/MEPS participants, 10,054 adults and 3,871 children met inclusion criteria. Model estimates indicated that food insecure adults had annual health care expenditures that were $1,834 (95% confidence interval [CI], $1,073-$2,595, P < .001) higher than food secure adults. For children, estimates were $80 higher, but this finding was not significant (95% CI, -$171 to $329, P = .53). The median annual health care cost associated with food insecurity was $687,041,000 (25th percentile, $239,675,000; 75th percentile, $1,140,291,000). The median annual county-level health care cost associated with food insecurity was $4,433,000 (25th percentile, $1,774,000; 75th percentile, $11,267,000). Cost variability was related primarily to food insecurity prevalence.

Conclusions: Health care expenditures associated with food insecurity vary substantially across states and counties. Food insecurity policies may be important mechanisms to contain health care expenditures.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Health care costs associated with food insecurity (A) and per capita health care costs associated with food insecurity (B), by state, United States, 2012–2013.
Figure 2
Figure 2
Health care costs associated with food insecurity (A) and per capita health care costs associated with food insecurity (B), by county, United States, 2012–2013.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2017. https://www.ers.usda.gov/publications/pub-details/?pubid=90022. Accessed September 25, 2018.
    1. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood) 2015;34(11):1830–9. 10.1377/hlthaff.2015.0645 - DOI - PubMed
    1. Berkowitz SA, Berkowitz TSZ, Meigs JB, Wexler DJ. Trends in food insecurity for adults with cardiometabolic disease in the United States: 2005-2012. PLoS One 2017;12(6):e0179172. 10.1371/journal.pone.0179172 - DOI - PMC - PubMed
    1. Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. J Gen Intern Med 2007;22(7):1018–23. 10.1007/s11606-007-0192-6 - DOI - PMC - PubMed
    1. Crews DC, Kuczmarski MF, Grubbs V, Hedgeman E, Shahinian VB, Evans MK, et al. ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. Effect of food insecurity on chronic kidney disease in lower-income Americans. Am J Nephrol 2014;39(1):27–35. 10.1159/000357595 - DOI - PMC - PubMed

Publication types