Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Department of Health Policy and Management, Texas A&M University, College Station, TX, USA.
Ethn Health. 2023 Jul;28(5):794-808. doi: 10.1080/13557858.2022.2161090. Epub 2022 Dec 28.
Food insecurity is a risk factor for morbidity and mortality leading to high medical expenditures, but race/ethnicity was used as adjustments in the literature. The study sought to use race/ethnicity as a key predictor to compare racial differences in associations between food insecurity and expenditures of seven health services among non-institutionalized adults.
This cross-sectional study used Medical Expenditure Panel Survey that collects information on food insecurity in 2016 (n=24,179) and 2017 (n=22,539). We examined the association between race/ethnicity and food insecurity status and documented the extent to which impacts of food insecurity on medical expenditures varied by race/ethnicity. We fit multivariable models for each racial group, adjusting for states, age, gender, insurance, and education. Adults older than 18 years were included.
The results show that blacks experienced an inter-racial disparity in food insecurity whereas Hispanics experienced intra-racial disparity. A higher percentage of blacks (28.7%) reported at least one type of food insecurity (11.2% of whites). Around 20% of blacks reported being worried about running out of food and the corresponding number is 8.4% among whites. Hispanics reported more food insecurity issues than whites. Moreover, food insecurity is positively associated with expenditures on emergency room utilization (99% increase for other races vs. 51% increase for whites) but is negatively associated with dental care utilization (43% decrease for blacks and 44% for whites). Except for Hispanics, prescription expenditure has the most positive association with food insecurity, and food insecure blacks are the only group that did not significantly use home health.
The study expanded our understanding of food insecurity by investigating how it affected seven types of medical expenditures for each of four racial populations. An interdisciplinary effort is needed to enhance the food supply for minorities. Policy interventions to address intra-racial disparities among Hispanics and inter-racial disparities among African Americans are imperative to close the gap.
食物不安全是导致发病率和死亡率上升以及医疗支出增加的风险因素，但种族/民族在文献中被用作调整因素。本研究旨在使用种族/民族作为关键预测因素，比较非住院成年人中食物不安全与七种卫生服务支出之间关联的种族差异。
本横断面研究使用了 2016 年（n=24179）和 2017 年（n=22539）的医疗支出面板调查来收集食物不安全信息。我们检查了种族/民族与食物不安全状况之间的关联，并记录了食物不安全对医疗支出的影响在多大程度上因种族/民族而异。我们为每个种族群体拟合了多变量模型，调整了州、年龄、性别、保险和教育因素。纳入年龄大于 18 岁的成年人。
结果表明，黑人经历了种族间的食物不安全差异，而西班牙裔则经历了种族内的差异。较高比例的黑人（28.7%）报告至少有一种类型的食物不安全（白人中为 11.2%）。大约 20%的黑人报告担心食物会用完，而白人对应的数字是 8.4%。西班牙裔报告的食物不安全问题多于白人。此外，食物不安全与急诊室利用率的支出呈正相关（其他种族增加 99%，而白人增加 51%），但与牙科保健利用率呈负相关（黑人减少 43%，白人减少 44%）。除了西班牙裔，处方药支出与食物不安全的关联最正，食物不安全的黑人是唯一一组未显著使用家庭健康的群体。
本研究通过调查食物不安全如何影响四种种族群体的七种类型的医疗支出，扩展了我们对食物不安全的理解。需要开展跨学科努力来增强少数民族的食物供应。解决西班牙裔内部差异和非裔美国人之间种族间差异的政策干预措施对于缩小差距至关重要。
