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The association between household food insecurity and healthcare costs among Canadian children

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To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada.


We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007–2008, 2009–2010, 2011–2012, 2013–2014) linked with administrative health databases (ICES). We included Ontario children aged 1–17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log–transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries).


We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services.


Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.



Examiner la relation entre l’insécurité alimentaire des ménages et les coûts des soins de santé chez les enfants vivant en Ontario, au Canada.


Nous avons mené une étude populationnelle transversale en utilisant les quatre cycles de l’Enquête sur la santé dans les collectivités canadiennes (2007–2008, 2009–2010, 2011–2012, 2013–2014) liés à des bases de données administratives sur la santé (ICES). Nous avons inclus les enfants ontariens de 1 à 17 ans et un indicateur d’insécurité alimentaire des ménages (le Module d’enquête sur la sécurité alimentaire des ménages) au cours des 12 mois antérieurs. Les coûts directs des soins de santé publics par enfant au cours de cette période (en dollars canadiens de 2020) ont constitué notre résultat principal. Nous avons utilisé des équations d’estimation généralisées transformées par la fonction logarithme gamma tenant compte du regroupement des enfants pour analyser cette relation, et des modèles ajustés pour les covariables sociodémographiques importantes. Comme résultat secondaire, nous avons analysé l’utilisation de certains services de soins de santé (p. ex. les visites dans les hôpitaux, les chirurgies) et les coûts associés.


Nous avons constaté que les coûts ajustés des soins de santé étaient plus élevés chez les enfants des ménages aux prises avec l’insécurité alimentaire que chez ceux des ménages à l’abri de l’insécurité alimentaire (676,79 $ [IC de 95%: 535,26 $, 855,74 $] contre 563,98 $ [457,00 $, 695,99 $], p = 0,047). Comparativement aux enfants des ménages à l’abri de l’insécurité alimentaire, ceux qui vivaient dans des ménages aux prises avec l’insécurité avaient plus souvent recours aux hôpitaux, aux services des urgences, aux chirurgies d’un jour et aux soins à domicile, et ils prenaient des médicaments sur ordonnance. Les enfants des ménages à l’abri de l’insécurité alimentaire avaient plus souvent recours aux soins de santé non médicaux (p. ex. l’optométrie) et aux services de leur médecin de famille attitré.


Même après l’apport d’ajustements pour tenir compte des déterminants sociaux de la santé mesurables, l’insécurité alimentaire des ménages était associée à des coûts de soins de santé publics plus élevés et à une plus grande utilisation de ces soins chez les enfants et les jeunes. Des efforts pour atténuer l’insécurité alimentaire pourraient réduire les besoins de soins de santé des enfants, ainsi que les coûts associés pour nos systèmes de soins de santé.

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Availability of data, material, and codes

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at (email: The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.


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This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from Canada Post Corporation and Statistics Canada. We thank the Toronto Community Health Profiles Partnership for providing access to the Ontario Marginalization Index. Parts or whole of this material are based on data and/or information compiled and provided by Immigration, Refugees and Citizenship Canada (IRCC). The CCHS is adapted from Statistics Canada. This does not constitute an endorsement by Statistics Canada of this product. Parts of this material are based on data and/or information compiled and provided by the MOH, MLTC, CIHI, and IRCC. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended nor should be inferred.


This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). It was conducted at ICES Western which receives funding from Western University, the Schulich School of Medicine and Dentistry, Lawson Health Research Institute and the Academic Medical Organization of Southwestern Ontario. This study also received funding from the Children’s Health Research Institute Internal Research Fund.

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Clemens conceptualized the study, developed the protocol, interpreted results, and drafted the manuscript. Le helped to develop the protocol and analyzed results, and revised the manuscript’s methodology and results. Anderson helped to design the protocol, planned the analysis, interpreted results, and ensured the accuracy and quality of the manuscript. Comeau helped conceptualize the study, develop the protocol, and interpret the socioeconomic analysis, and she reviewed the manuscript critically for its content. Tarasuk designed the protocol, planned analysis, interpreted project outputs, and contributed meaningfully to all parts of the manuscript. Shariff conceptualized the study, planned database linkage, developed the protocol, interpreted findings, and developed the manuscript. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Kristin K. Clemens.

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ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement. Use of data in this project was authorized under Sect. 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a Research Ethics Board.

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The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended nor should be inferred.

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Clemens, K.K., Le, B., Anderson, K.K. et al. The association between household food insecurity and healthcare costs among Canadian children. Can J Public Health 115, 89–98 (2024).

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