Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use

Abstract

Introduction: Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients. Methods: We completed survey questionnaires with randomly sampled adult patients from an urban public hospital ED (n = 2,312). We assessed food insecurity using four questions from the United States Department of Agriculture Household Food Security Survey. The primary independent variable was any food insecurity, defined as an affirmative response to any of the four items. Frequent ED use was defined as self-report of ≥4 ED visits in the past year. We examined the relationship between patient food insecurity and frequent ED use using bivariate and multivariable analyses and examined possible mediation by anxiety/depression and overall health status. Results: One-third (30.9%) of study participants reported frequent ED use, and half (50.8%) reported any food insecurity. Prevalence of food insecurity was higher among frequent vs. non-frequent ED users, 62.8% vs 45.4% (P <0.001). After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use (adjusted odds ratio 1.48, 95% confidence interval, 1.20-1.83). This observed association was partially attenuated when anxiety/depression and overall health status were added to models. Conclusion: The high observed prevalence of food insecurity suggests that efforts to improve care of ED patients should assess and address this need. Further research is needed to assess whether addressing food insecurity may play an important role in efforts to reduce frequent ED use for some patients.

Examining food insecurity in a regional New Zealand emergency department: A cross‐sectional study

“…This is in contrast to earlier studies by Estrella et al that showed higher ED usage among FI individuals (adjusted OR 1.48 [95% CI 1.20-1.83]) and by Ghani et al who found higher ED utilisation rates among those with chronic conditions who experienced FI as compared to those who were food secure (adjusted incident rate ratio 1.90 [95% CI 1.20-3.01]). 19,21 Our study did not show differences in FI based on acuity level or medical comorbidities, which was similar to other ED-based studies of FI. 8,10 This differs from population studies of children and adolescents in NZ that showed an association with FI and comorbidities 5,6 ; perhaps this difference could be explained by the ED-based setting and inclusion of participants of all ages.…”

“…This is consistent with results from studies performed in the USA showing a higher prevalence of FI in the ED setting compared to the community setting, with rates as high as 45.6% in paediatric EDs and 50.8% in adult EDs. 9,19 EDs often serve as society's safety net and as such may see a disproportionate number of food insecure individuals. Thus, EDs could be an ideal setting for a FI screening programme.…”

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

“…66,67 Food insecurity is also associated with greater emergency department visits and inpatient hospitalizations. [68][69][70][71][72][73][74] These "big ticket" forms of healthcare utilization in turn drive greater healthcare spending for individuals experiencing food insecurity. [75][76][77] All of these compensatory effects can create negative long-term health consequences.…”

Impact of COVID-19 Pandemic on Food Insecurity in an Urban Emergency Department Patient Population

“…8 The prevalence of FI and hunger in the ED population has historically been higher than among the general public. 2,10 Therefore, the ED environment represents a unique opportunity for physicians to identify patients with FI. Our goal in this study was to assess the impact of the COVID-19 pandemic on the prevalence of FI in the ED patient population.…”