July 25, 2022
When you aren’t sure where your next meal is coming from, you’re more likely to miss work for health reasons and to spend time in the hospital — especially if you live with Type 2 diabetes.
These findings come from three UNC-Chapel Hill researchers who studied the associations between food insecurity, health-related missed workdays and overnight hospitalizations among working-age adults with the disease.
In 2020, an estimated 10.5% of United States households experienced food insecurity, defined as “the limited or uncertain availability of nutritionally adequate or safe foods.”
Dr. Seth Berkowitz
Dr. Anna Kahkoska
Joshua Weinstein
Lead author Joshua Weinstein, MPP, is a doctoral candidate in the Department of Health Policy and Management at the UNC Gillings School of Global Public Health. His co-authors are Anna Kahkoska, MD, PhD, assistant professor of nutrition at the Gillings School, and Seth Berkowitz, MD, MPH, assistant professor in the Division of General Medicine and Clinical Epidemiology at the UNC School of Medicine.
Previous research has shown that food insecurity is more common among people with Type 2 diabetes, and it affect diabetes management in several ways. Food insecurity goes hand-in-hand with a low-quality diet, particularly when people are forced to choose between paying for food or medication and medical supplies.
When choosing to eat means forgoing necessary medicine or monitoring blood glucose levels less frequently, people can experience higher stress, worse mental health and negative physical health outcomes.
“A key concern is that the experience of food insecurity may create a vicious cycle whereby food insecurity can worsen health, resulting in hospitalizations and missed work,” the authors write. “The resulting missed work can lower income, thereby increasing the risk for and extent of food insecurity.”
When the researchers analyzed National Health Interview Survey data from 13,116 U.S. adults (ages 18 to 65) with diabetes, they found that experiencing food insecurity, compared with being food secure, was associated with more than twice the rate of health-related missed workdays and increased odds of overnight hospitalization within the prior twelve months.
“These findings underscore the broad impacts of food insecurity on health and wellness for working-age adults with diabetes,” the study team writes. “When weighing the costs and benefits of proposed interventions to address food insecurity, policy makers should consider potential benefits related to productivity in addition to implications for health care use.”
Read the full article, titled “Food Insecurity, Missed Workdays, And Hospitalizations Among Working-Age US Adults With Diabetes,” at Health Affairs.
Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.


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