The societal costs of food insecurity: implications for managed care strategies

To estimate the direct health care costs and indirect economic implications of food insecurity among working-age adults in the US from a societal perspective.

We conducted a retrospective longitudinal cohort study using the 2016-2017 and 2021-2022 Medical Expenditure Panel Survey.

Our sample included 17,524 working-age adults. Our outcomes included health care spending, employment status, and income. The primary independent variable was food insecurity. Lagged dependent variable models assessed the association between food insecurity in year 1 and outcomes in year 2, adjusting for baseline characteristics.

Our lagged dependent variable models showed that food insecurity was not associated with total health care spending in year 2, but it was associated with a $132 (95% CI, $25-$239) increase in emergency department spending. Although food insecurity was not associated with employment, it was associated with increased likelihood of having a seasonal job or a temporary job and missing work due to illness in year 2 by 2.4 (95% CI, 1.0-3.8), 3.7 (95% CI, 1.1-6.3), and 4.8 (95% CI, 1.9-7.7) percentage points, respectively. Furthermore, food insecurity was associated with a decrease of $2521 (95% CI, -$4129 to -$914) in annual individual-level income in year 2, which was primarily driven by a decline in wages of $2030 (95% CI, -$3438 to -$621).

Food insecurity was associated with economic burdens beyond medical spending, particularly through lost income and employment instability. These findings suggest that food insecurity is linked to economic instability while placing targeted demands on the health system, underscoring the importance of addressing food insecurity as a policy and public health priority.