Treffeisen Elsa R, Aziz-Bose Rahela, Gundewar Anisha U, Hammad Nour M, Leung Cindy W
Division of Immunology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Hematology and Oncology, Boston Children's Hospital, Boston, MA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.
J Pediatr. 2025 Aug;283:114631. doi: 10.1016/j.jpeds.2025.114631. Epub 2025 Apr 30.
To characterize the association between medical debt and food insecurity in a recent nationally representative sample of US families with children, and to assess whether family income or health insurance type modifies this association.
We conducted a cross-sectional study of US parents using the 2019-2023 National Health Interview Survey. Multivariable logistic regression models, adjusted for sociodemographic characteristics and survey year, assessed the association between medical debt, defined as self-reported inability to pay medical bills, and food insecurity. We tested for effect modification and conducted stratified analyses by the ratio of family income to the poverty threshold and by health insurance type.
Among 29 260 parents, 7.9% experienced family medical debt and 8.8% reported family food insecurity. Families with medical debt had 4.04-fold odds of food insecurity (95% CI: 3.49, 4.67; P < .001) compared with families without medical debt. This association was present across all income groups (P < .001) and was modified by family income (P-interaction <.001), with middle-income families (200%-399% federal poverty level) experiencing the strongest association (aOR: 6.91; 95% CI: 5.28, 9.05; P < .001). Similarly, insurance type modified the association between medical debt and food insecurity (P-interaction 0.002), with families with a privately insured parent experiencing the strongest association (aOR 5.71; 95% CI 4.57, 7.13; P < .001).
Medical debt is associated with increased odds of food insecurity among families with children. These consequences disproportionately impact middle-income and privately insured families, highlighting the importance of comprehensive policies to prevent and mitigate medical debt and food insecurity in pediatric settings.
在近期具有全国代表性的有子女美国家庭样本中，描述医疗债务与粮食不安全之间的关联，并评估家庭收入或医疗保险类型是否会改变这种关联。
我们使用2019 - 2023年全国健康访谈调查对美国父母进行了一项横断面研究。多变量逻辑回归模型在对社会人口学特征和调查年份进行调整后，评估了自我报告无法支付医疗账单所定义的医疗债务与粮食不安全之间的关联。我们检验了效应修正，并按家庭收入与贫困线的比率以及医疗保险类型进行了分层分析。
在29260名父母中，7.9%经历过家庭医疗债务，8.8%报告有家庭粮食不安全问题。与没有医疗债务的家庭相比，有医疗债务的家庭粮食不安全的几率高出4.04倍（95%置信区间：3.49，4.67；P <.001）。这种关联在所有收入组中均存在（P <.001），并且受到家庭收入的影响（P交互作用<.001），中等收入家庭（联邦贫困水平的200% - 399%）的关联最强（调整后比值比：6.91；95%置信区间：5.28，9.05；P <.001）。同样，保险类型也改变了医疗债务与粮食不安全之间的关联（P交互作用0.002），有私人保险父母的家庭关联最强（调整后比值比5.71；95%置信区间4.57，7.13；P <.001）。
医疗债务与有子女家庭粮食不安全几率增加有关。这些后果对中等收入和有私人保险的家庭影响尤为严重，凸显了制定综合政策以预防和减轻儿科环境中的医疗债务和粮食不安全的重要性。
