Chronic Conditions and Food Insecurity in US Children.

Importance: Food insecurity is associated with adverse health outcomes in children. There are few recent national studies comparing the prevalence of food insecurity among children with and without chronic conditions. Objective: To compare the prevalence of food insecurity in children with and without chronic conditions. Design, Setting, and Participants: This cross-sectional study included children ages 2 to 17 years in the 2019-2023 National Health Interview Survey (NHIS). Data were analyzed December 2024 through February 2025. Exposure: Reporting any of 7 chronic conditions included in the NHIS: asthma, attention-deficit/hyperactivity disorder, autism spectrum disorder, developmental delay, intellectual disability, learning disability, and prediabetes or diabetes. Main Outcomes and Measures: Food insecurity, defined as low or very low food security in the preceding 30 days. We calculated the prevalence of food insecurity among children with and without any of the 7 chronic conditions, both across the study period and by year. To evaluate whether any differences reflected confounding by demographic characteristics, logistic regression models were fitted that controlled for family characteristics (income, education, number of children and parents, number of employed adults, urbanicity, census region) and child characteristics (age, sex, self-reported race and ethnicity, disability, health insurance type). Results: Analyses included a weighted sample of 63 163 342 children, of whom 51.1% (95% CI, 50.5%-51.7%) were female with a mean (SD) age of 9.6 (4.6) years. The most common conditions were ADHD (8.6%; 95% CI, 8.2%-9.0%) and asthma (7.0%; 95% CI, 6.7%-7.3%). Across the study period, the weighted prevalence of food insecurity among children with and without chronic conditions was 14.8% (95% CI, 13.7%-16.0%) and 9.0% (95% CI, 8.5%-9.5%), respectively. This difference was attenuated but persisted after controlling for family and child characteristics (average marginal effect, 2.6 percentage points; 95% CI, 1.7 to 3.5 percentage points). In 2021, the prevalence of food insecurity among children with and without chronic conditions decreased to 9.7% (95% CI, 8.1%-11.7%) and 6.6% (95% CI, 5.8%-7.6%), respectively, but then increased to 15.9% (95% CI, 13.9%-18.2%) and 11.1% (95% CI, 10.1%-12.1%), respectively, by 2023. Conclusions and Relevance: In this cross-sectional analysis, children were more likely to have food insecurity if they had chronic conditions than if they did not. This difference was only partially explained by several key demographic characteristics. Findings suggest children with chronic conditions should be prioritized in efforts to screen for food insecurity and efforts to enroll patients in programs designed to mitigate food insecurity.