The association between household food insecurity and healthcare costs among Canadian children

• Published in: Canadian journal of public health 2024-02, Vol.115 (1), p.89-98
• Main Authors: Clemens, Kristin K., Le, Britney, Anderson, Kelly K., Comeau, Jinette, Tarasuk, Valerie, Shariff, Salimah Z.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Children; Childrens health; Clustering; Cross-Sectional Studies; Emergency medical care; Emergency medical services; Food Insecurity; Food security; Food Supply; Health care; Health Care Costs; Health care expenditures; Health services; Health services utilization; Hospitals; Households; Humans; Medicine; Medicine & Public Health; Ontario; Optometry; Original; Original Article; Physicians; Population studies; Public Health; Surveys
• ISSN: 0008-4263; 1920-7476; 1920-7476
• DOI: 10.17269/s41997-023-00812-2

Objective To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada. Methods We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007–2008, 2009–2010, 2011–2012, 2013–2014) linked with administrative health databases (ICES). We included Ontario children aged 1–17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log–transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries). Results We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p  = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services. Conclusion Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.