The Association between Medical Debt and Food Insecurity among United States Families with Children

To characterize the association between medical debt and food insecurity in a recent nationally representative sample of US families with children, and to assess whether family income or health insurance type modifies this association.

We conducted a cross-sectional study of US parents using the 2019-2023 National Health Interview Survey. Multivariable logistic regression models, adjusted for sociodemographic characteristics and survey year, assessed the association between medical debt, defined as self-reported inability to pay medical bills, and food insecurity. We tested for effect modification and conducted stratified analyses by the ratio of family income to the poverty threshold and by health insurance type.

Among 29 260 parents, 7.9% experienced family medical debt and 8.8% reported family food insecurity. Families with medical debt had 4.04-fold odds of food insecurity (95% CI: 3.49, 4.67; P < .001) compared with families without medical debt. This association was present across all income groups (P < .001) and was modified by family income (P-interaction <.001), with middle-income families (200%-399% federal poverty level) experiencing the strongest association (aOR: 6.91; 95% CI: 5.28, 9.05; P < .001). Similarly, insurance type modified the association between medical debt and food insecurity (P-interaction 0.002), with families with a privately insured parent experiencing the strongest association (aOR 5.71; 95% CI 4.57, 7.13; P < .001).

Medical debt is associated with increased odds of food insecurity among families with children. These consequences disproportionately impact middle-income and privately insured families, highlighting the importance of comprehensive policies to prevent and mitigate medical debt and food insecurity in pediatric settings.