State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity
State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity
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DOI：
10.5888/pcd16.180549
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发表时间：
2019-07-01
影响因子：
5.5
通讯作者：
Seligman, Hilary K.
中科院分区：
文献类型：
--
作者：
Berkowitz, Seth A.;Basu, Sanjay;Seligman, Hilary K.
粮食不安全，或由于有限的财政资源而无法获得粮食，与较高的医疗保健支出有关。然而，在美国，粮食不安全的流行率和医疗保健支出差异很大。为了向公共政策提供信息，我们估计了与粮食不安全相关的州级和县级医疗保健支出。方法我们使用了2011-2013年全国健康访谈调查/医疗支出小组调查数据（NHIS/MEPS）数据，以估计与粮食不安全相关的平均医疗保健费用，绘制膳食差距数据，以估计州和县一级的粮食不安全流行率（当前至2016年）和达特茅斯医疗保健数据地图集，以说明当地医疗保健价格和使用强度的差异。我们使用有针对性的最大似然估计估计与粮食不安全，分别为成人和儿童，调整sociodemographic characteristics.ResultsAmong NHIS/MEPS参与者，10,054成人和3,871儿童符合纳入标准的医疗费用。模型估计表明，粮食不安全的成年人每年的医疗保健支出为1，834美元（95%置信区间[CI]，1，073 - 2，595美元，P < .001），高于粮食安全的成年人。对于儿童，估计值高出80美元，但这一发现并不显著（95% CI，-171美元至329美元，P= 0.53）。与粮食不安全相关的年度医疗保健费用中位数为687 041 000美元（第25百分位数，239 675 000美元;第75百分位数，1 140 291 000美元）。与粮食不安全相关的县级年度医疗保健费用中位数为4 433 000美元（第25百分位数，1 774 000美元;第75百分位数，11 267 000美元）。成本的变化主要与粮食不安全的患病率。ConclusionsHealth care expenditures associated with food insecurity varies substantially across states and counties.粮食不安全政策可能是控制保健支出的重要机制。
IntroductionFood insecurity, or uncertain access to food because of limited financial resources, is associated with higher health care expenditures. However, both food insecurity prevalence and health care spending vary widely in the United States. To inform public policy, we estimated state-level and county-level health care expenditures associated with food insecurity.MethodsWe used linked 2011-2013 National Health Interview Survey/ Medical Expenditure Panel Survey data (NHIS/MEPS) data to estimate average health care costs associated with food insecurity, Map the Meal Gap data to estimate state-level and county-level food insecurity prevalence (current though 2016), and Dartmouth Atlas of Health Care data to account for local variation in health care prices and intensity of use. We used targeted maximum likelihood estimation to estimate health care costs associated with food insecurity, separately for adults and children, adjusting for sociodemographic characteristics.ResultsAmong NHIS/MEPS participants, 10,054 adults and 3,871 children met inclusion criteria. Model estimates indicated that food insecure adults had annual health care expenditures that were $1,834 (95% confidence interval [CI], $1,073-$2,595, P < .001) higher than food secure adults. For children, estimates were $80 higher, but this finding was not significant (95% CI, -$171 to $329, P= .53). The median annual health care cost associated with food insecurity was $687,041,000 (25th percentile, $239,675,000; 75th percentile, $1,140,291,000). The median annual county-level health care cost associated with food insecurity was $4,433,000 (25th percentile, $1,774,000; 75th percentile, $11,267,000). Cost variability was related primarily to food insecurity prevalence.ConclusionsHealth care expenditures associated with food insecurity vary substantially across states and counties. Food insecurity policies may be important mechanisms to contain health care expenditures.