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This study explores the association between household food security status and physical health conditions among U.S. adults from 2019 to 2023, utilizing nationally representative data from the National Health Interview Survey. Using a sample of 134,904 American adults, the study examines how food insecurity affects self-rated health status and the prevalence of chronic illnesses, with further analyses of inequalities based on urban-rural residency and racial/ethnic identities. Multivariable logistic regression models, controlling for socioeconomic, demographic, and behavioral variables, indicate that adults facing food insecurity exhibit significantly higher odds of reporting poor or fair self-rated health (OR = 2.43) and were at heightened risk for various chronic conditions, including heart attack (OR = 1.74), stroke (OR = 1.71), coronary heart disease (OR = 1.67), diabetes (OR = 1.64), hypertension (OR = 1.41), high cholesterol (OR = 1.40), and cancer (OR = 1.23). The findings demonstrate that food insecurity serves as a strong and consistent predictor of adverse health outcomes. Disparities were notably evident among racial/ethnic minorities, particularly non-Hispanic Black and Hispanic adults, as well as rural populations, highlighting the interconnected influences of systemic inequality, geographic isolation, and neighborhood disadvantages. These findings underscore the importance of incorporating structural interventions into public health and food assistance policies to tackle the underlying causes of food insecurity and chronic illness in marginalized communities.