Health insurance participation may mitigate the health impact of food insecurity among Chinese working-age adults

In mainland China, approximately 250 million people are unable to afford healthy meals. Food insecurity has been linked to poorer health outcomes in western countries, yet its impact remains understudied in China, especially among working-age adults. We analyzed cross-sectional data from an online survey conducted in 2024 with 4,795 individuals aged 30-60 from three Chinese provinces. Respondents self-reported chronic conditions, mental disorders, disabilities, and doctor visits. Household food insecurity was assessed by the FAO's Food Insecurity Experience Scale (FIES). The results showed that food insecurity was positively associated with chronic conditions, mental disorders, disabilities, and doctor visits in a dose-response fashion after confounders adjustment. Health insurance participation mitigated the association of food insecurity with chronic conditions and doctor visits. Healthcare accessibility, dietary quality, social support, and psychological chronic stress partially mediated the food insecurity-health relationship. Efforts to broaden and upgrade health insurance coverage and promote healthcare accessibility may help reduce health inequity across food security levels.