A recent analysis of the 2019 to 2023 National Health Interview Survey demonstrated that US children with common chronic conditions (i.e., asthma, attention-deficit/hyperactivity disorder, autism spectrum disorder, developmental delay, intellectual disability, learning disability, and prediabetes or diabetes) face a significantly higher prevalence of food insecurity than their peers without chronic conditions. This gap persisted even after adjusting for socioeconomic and demographic factors.
Food insecurity can worsen some chronic conditions by increasing stress and leading to worse mental health, or through a relation to lower diet quality and an increased risk of diabetes, Nina E. Hill, MD, of the University of Michigan Medical School in Ann Arbor explained with colleagues. They noted that food insecurity is also associated with asthma, anemia, and other adverse health outcomes in children. To the authors’ knowledge, the analysis is the first of its kind for children that examines the association between having a broad range of common chronic conditions and household food insecurity.
In their analysis, the researchers found that the unadjusted prevalence of food insecurity was about 15% in children with chronic conditions vs 9% in those without. With adjustments for income, parental education, household structure, region, and child demographic characteristics in the pooled cross-sectional analysis, "the higher prevalence of food insecurity among children with any chronic condition attenuated but persisted (average marginal effect [AME] 2.6 percentage points)," the authors wrote.
Stratified analyses revealed that among the conditions studied, the strongest adjusted association was with prediabetes or diabetes, with an AME of 4.7 percentage points, followed by intellectual disability (AME 3.6), asthma (AME 3.2), autism (AME 2.2), attention-deficit/hyperactivity disorder (AME 1.9), and learning disability (AME 1.8). In children with multiple conditions, the numbers increased even further, with an AME of 3.9 percentage points among those with two conditions, and 3 percentage points among those with three or more. "The weighted prevalence of food insecurity among children with 1, 2, or 3 or more chronic conditions was about 13%, 17%, and 20%, respectively," the authors wrote.
Notably, the data showed a dip in food insecurity around 2021 (about 10% for participants with chronic conditions, and 7% for those without chronic conditions), which rebounded in 2023 (16% for participants with chronic conditions and 11% for those without chronic conditions). The authors suggested that pandemic-era support (e.g., stimulus payments, expanded child tax credits, SNAP/WIC enhancements) may have temporarily narrowed the gap.
The researchers surveyed over 63 million children aged 2 to 17 years annually. When they looked at the 7 chronic conditions included in the National Health Interview Survey, they also found that 20% of the children sampled had at least one chronic condition. Race and ethnicity were self-reported: 52% were White, 26% were Hispanic, 12% were Black, 5% were Asian, and 2% were non-Hispanic American Indian or Alaska Native. Descriptive statistics were then used to calculate the prevalence of food insecurity, both overall and by survey year.
The study authors noted the possible bidrirectional relationship between chronic conditions and food insecurity: while food insecurity can worsen diet quality and exacerbate health conditions, chronic health conditions may lead to food insecurity as a result of lost and low income when people are unable to work. To combat this multifaceted issue, the authors recommended changes at the policy level, including interventions to mitigate the adverse health effects of food insecurity and investing in Food is Medicine programs, which may help to close the extant gaps.
The authors’ disclosures can be found in the published study.