Sixty percent of U.S. adults have at least 1 chronic illness, which are leading causes of death, disability, and health care spending (CDC, 2021). Risk and access to treatment for chronic illness vary across individuals and populations. Social determinants of health (SDOH), or the environmental conditions in which people live, contribute greatly to health risks, outcomes, and well-being (Healthy People 2030, 2021). Social workers are well positioned to address SDOH through clinical practice and policy advocacy, as highlighted in the 2019 National Academies Report, “Integrating Social Care into the Delivery of Health Care.” As the report states, “Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system.” One SDOH that has received increased attention during the pandemic is food insecurity. Impacting over 38 million people, food insecurity negatively effects overall well-being and is related to increased health care spending (Leddy et al., 20202; Dean, 2020). The current study aims to better understand the relationship between food insecurity and chronic illness.
We used the 2016 Medical Expenditure Panel Survey and Food Security Supplement to examine relationships between food security and chronic illness (N=34,655). The supplement included 10 food security questions, based on a validated instrument from the USDA. Food insecurity was coded and defined as 2 or more positive responses, in accordance with the USDA instrument. Chronic illness was defined as any diagnosis of heart disease, cancer, stroke, COPD or diabetes. Descriptive statistics explore the prevalence of food security among individual with chronic illnesses. Associations between food security and chronic illness were tested using multivariate logistic regression, controlling for socio-demographics, and other SDOH.
Results indicate that 32% of respondents diagnosed with COPD, 28% of respondents diagnosed with stroke, 25% of respondents diagnosed with diabetes, 22% of respondents diagnosed with heart disease, and 17% of respondents diagnosed with cancer were food insecure.
Further, we found that there is a strong relationship between food insecurity and the diagnosis of chronic illness overall (OR: 1.14; 95% CI: 1.04, 1.24) compared to those not diagnosed with a chronic illness. Other characteristics significantly associated with chronic illness include: unemployment compared to being employed; high school education or less compared to college education; and not having a regular source of health care compared to having a primary care provider.
Rates of food insecurity among those with chronic illness are higher than the general population, with those with pulmonary disease having the highest rates. There is a strong relationship overall between food insecurity and chronic illness. There are likely complex and bidirectional pathways between food insecurity and chronic illnesses, as research on health care spending and food insecurity has found. Social workers are positioned to address SDOH such as food insecurity by spearheading clinical programs (e.g. screening & intervention such as food pantries in healthcare settings) as well as advocating for policy changes (e.g. SNAP).