Food Insecurity and Health Care Expenditures in the United States, 2011-2013

Health Serv Res. 2018 Jun;53(3):1600-1620. doi: 10.1111/1475-6773.12730. Epub 2017 Jun 13.


Objective: To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures.

Data source/study setting: Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]).

Study design: Longitudinal retrospective cohort.

Data collection/extraction methods: A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area.

Principal findings: Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually.

Conclusions: Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs.

Keywords: Food insecurity; cardiovascular disease; diabetes, cardiovascular disease; health expenditures; hypertension; socioeconomic status.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Child
  • Child, Preschool
  • Chronic Disease / economics
  • Chronic Disease / epidemiology
  • Cross-Sectional Studies
  • Female
  • Food Supply / statistics & numerical data*
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Income / statistics & numerical data
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Residence Characteristics
  • Retrospective Studies
  • Sex Factors
  • Socioeconomic Factors
  • United States
  • Young Adult