Food Insecurity Among Medicare Beneficiaries in 2017-2022: A Longitudinal Cohort Study

Food insecurity affects many older adults and is associated with a range of adverse health outcomes. However, most prior research has relied on cross-sectional data, and evidence on predictors of subsequent food insecurity among Medicare beneficiaries remains limited.

We conducted a retrospective longitudinal cohort study of 12,029 individuals using 2017-2022 Medicare Current Beneficiary Survey data. We applied linear lagged dependent variable models to estimate predicted probabilities of food insecurity in the subsequent year, based on the prior year's demographics, socioeconomic characteristics, health conditions, and food insecurity status. Food insecurity was assessed using the USDA's 6-item short-form survey. Demographic and socioeconomic characteristics were measured from self-reported survey responses, and health conditions were identified using medical claims data.

In adjusted linear probability models, the strongest predictor of subsequent-year food insecurity was prior-year food insecurity, which is associated with a 43 percentage point (p.p.) higher probability of food insecurity in the subsequent year (95% CI: 38.7-47.2). Other important predictors included self-reported "poor" general health (6.5 p.p. [0.5-12.4]), inability to afford dental care (6.4 p.p [3.1-9.7]), difficulty paying medical bills (5.2 p.p. [1.5-8.9]), not filling prescriptions due to costs (4.4 p.p. [2.2-6.5]), and Hispanic ethnicity (4.1 p.p. [1.7-6.6]).

Among older Medicare beneficiaries, prior food insecurity and markers of acute financial strain, including difficulty affording dental care or prescriptions, strongly predict future food insecurity, even after adjusting for their income. Incorporating these indicators into screening efforts may improve identification of beneficiaries at risk of food insecurity. Furthermore, linking screening efforts with navigation and benefits enrollment support, alongside broader policy reforms to reduce financial strain, may help mitigate food insecurity and its downstream health consequences in this population.