Food insecurity in US surgical patients: Findings from the National Health Interview survey

IMPORTANCE: Food insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, little is known regarding its impact on surgical patients. 

OBJECTIVE: To assess food insecurity, identify associated characteristics, and measure the rate of Supplemental Nutrition Assistance Program (SNAP) enrollment among surgical patients using a nationally representative sample. 

DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study using National Health Interview Survey (NHIS) data from 2011 through 2018. These data were analyzed from February 2024 through April 2025. Multivariable logistic regression models were used to analyze the association between surgery, food insecurity, and enrollment in SNAP. Data for this study came from the NHIS, a nationally representative survey used for health information, health access, and health behaviors of the civilian, noninstitutionalized US population, enabling broad applicability to surgical patients. The study included 254 283 individuals with data on surgery within the past year and 30-day food insecurity. Surgical and nonsurgical cohorts were created based on answers to, "During the past 12 months, have you had surgery or other surgical procedures as an inpatient or outpatient?" 

EXPOSURES: The main exposure included undergoing surgery in the past year. Other exposures were age, race, sex, employment status, household income, marital status, number of family members in the household, geographic region, health status, and insurance status. 

MAIN OUTCOMES AND MEASURES: The proportion of food insecurity among the surgical cohort was the main outcome. Secondary outcomes included factors linked to food insecurity and SNAP enrollment, especially for those with incomes below 200% of the federal poverty level. 

RESULTS: Surgical patients (13 180 male [40.2%] and 19 643 female [59.8%]) reported higher food insecurity prevalence (11.6%) than nonsurgical patients (100 924 male [45.6%] and 120 536 female [54.4%]) (10.5%). Adjusted analyses indicated significantly higher odds of food insecurity among surgical patients (odds ratio, 1.12; 95% CI, 1.07-1.18; P < .001). Food insecurity was strongly linked to lower income and poor health. SNAP enrollment was 16% overall and 40% among surgical patients with incomes less than 200% federal poverty level, associated with younger, low-income, unemployed, less educated, or publicly insured patients. 

CONCLUSIONS AND RELEVANCE: Food insecurity is a significant burden among surgical patients. Interventions, including food insecurity screening, may improve food access and health outcomes in this cohort.