Food insecurity and acute care utilisation: a systematic review and meta-analysis

Introduction Food insecurity (FI) is inadequate access to food needed for normal growth, development and maintenance of an active and healthy lifestyle, due to economic barriers. FI is associated with poor physical and mental health, including worse outcomes in chronic health conditions. Existing research presents conflicting evidence regarding the relationship between FI and healthcare utilisation. Objective This systematic review and meta-analysis explores the association between FI and acute care utilisation status. Design Systematic review and meta-analysis. Data sources A systematic search was conducted in December 2024 in the electronic databases MEDLINE, EMBASE, APA PsycINFO, CINAHL and SocINDEX. Eligibility criteria Study inclusion criteria included: (1) reported associations between food insecurity and at least one acute care utilisation outcome of interest (hospitalisations, emergency department (ED) visit, readmission, hospital length of stay); (2) adult populations; and (3) original research. Data extraction and synthesis Two reviewers extracted data and assessed study quality using the Newcastle-Ottawa Scale. A meta-analysis was conducted for hospitalisations and ED outcomes. Results The search strategy identified 4410 studies; of these, 52 studies (with a total sample size of n=1 653 065) met criteria for inclusion into the systematic review. Most studies reported a significant association between FI and increased rates of acute care utilisation. Food insecurity was associated with both increased hospitalisations (pooled OR 1.44 (95% CI 1.26 to 1.66), n=19) and ED visits (pooled OR 1.61 (95% CI 1.39 to 1.87), n=13) in meta-analysis; however, statistical heterogeneity was high (I 2 =62.4% and 60.2%, respectively). Review limitations include a predominance of observational, often cross-sectional studies, substantial heterogeneity and mainly high-income countries included in the sample. Conclusions FI is associated with higher rates of acute care utilisation—in particular, hospitalisations and ED visits. Identifying food-insecure individuals and deploying strategies to address their economic and food-related needs is a health system priority.