Seth A Berkowitz1, Hilary K Seligman, James B Meigs, Sanjay Basu. 1. 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.
Abstract
OBJECTIVES: Reducing 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 DESIGN: Retrospective analysis of a nationally representative cohort. METHODS: Adults (≥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. RESULTS: Of 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. CONCLUSIONS: Food 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.
OBJECTIVES: Reducing 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 DESIGN: Retrospective analysis of a nationally representative cohort. METHODS: Adults (≥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. RESULTS: Of 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. CONCLUSIONS: Food 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.
Authors: Seth A Berkowitz; A Catherine Hulberg; Clemens Hong; Brian J Stowell; Karen J Tirozzi; Carine Y Traore; Steven J Atlas Journal: BMJ Qual Saf Date: 2015-11-30 Impact factor: 7.035
Authors: Hilary K Seligman; Andrew B Bindman; Eric Vittinghoff; Alka M Kanaya; Margot B Kushel Journal: J Gen Intern Med Date: 2007-04-11 Impact factor: 5.128
Authors: Deidra C Crews; Marie Fanelli Kuczmarski; Vanessa Grubbs; Elizabeth Hedgeman; Vahakn B Shahinian; Michele K Evans; Alan B Zonderman; Nilka Rios Burrows; Desmond E Williams; Rajiv Saran; Neil R Powe Journal: Am J Nephrol Date: 2014-01-08 Impact factor: 3.754
Authors: Seth A Berkowitz; Hilary K Seligman; Joseph Rigdon; James B Meigs; Sanjay Basu Journal: JAMA Intern Med Date: 2017-11-01 Impact factor: 21.873
Authors: Etienne J Phipps; S Brook Singletary; Clarissa A Cooblall; Horacio D Hares; Leonard E Braitman Journal: Popul Health Manag Date: 2016-03-23 Impact factor: 2.459
Authors: Seth A Berkowitz; Travis P Baggett; Deborah J Wexler; Karen W Huskey; Christina C Wee Journal: Diabetes Care Date: 2013-06-11 Impact factor: 19.112
Authors: Alicia J Cohen; James L Rudolph; Kali S Thomas; Elizabeth Archambault; Megan M Bowman; Christine Going; Michele Heisler; Thomas P O'Toole; David M Dosa Journal: Fed Pract Date: 2020-01
Authors: Caroline G Heller; Colin D Rehm; Amanda H Parsons; Earle C Chambers; Nicole H Hollingsworth; Kevin P Fiori Journal: Prev Med Date: 2021-08-01 Impact factor: 4.018
Authors: Javier A Tamargo; Jacqueline Hernandez-Boyer; Colby Teeman; Haley R Martin; Yongjun Huang; Angelique Johnson; Adriana Campa; Sabrina S Martinez; Tan Li; Susan D Rouster; Heidi L Meeds; Kenneth E Sherman; Marianna K Baum Journal: J Infect Dis Date: 2021-12-15 Impact factor: 5.226
Authors: Amy McQueen; Linda Li; Cynthia J Herrick; Niko Verdecias; Derek S Brown; Darrell J Broussard; Rachel E Smith; Matthew Kreuter Journal: Popul Health Manag Date: 2021-05-14 Impact factor: 2.459