The Prevalence and Perceived Health Consequences of Hunger in Emergency Department Patient Populations

Abstract

Objectives: Hunger is associated with chronic poor health and may force patients to make choices that acutely impact their health. This study was conducted to determine the prevalence of hunger, some of the choices it forces, and its perceived health effects among emergency department (ED) patients. Methods: A validated survey about hunger, choosing between food and medicine, and perceived adverse health outcomes was administered in English, Spanish, and Somali to non-critically ill ED patients or their parents. Demographics, rates of hunger, numbers of yearly ED visits, and decisions between buying commodities or medications were assessed. Relationships between variables were summarized with odds ratios (ORs), 95% confidence intervals, and logistic regression. Results: Of 930 respondents, 23.7% screened positive for hunger and 17.6% bought food instead of medications. Among the hunger-positive respondents, 44% believed this choice caused illness, and

Food Insecurity and Out‐of‐Pocket Medical Expenditures: Competing Basic Needs?

“…Of primary interest was the extent to which families exchange scarce resources to meet these needs and enhance their overall well‐being. Consistent with convenience sample‐based studies that asked people whether they had found themselves faced with the choice of seeking medical care and purchasing food (e.g., Biros et al., 2005; Kersey et al., 1999; Nelson et al., 1998), the results indicated that expenditures on one basic need (medical care) reduced the resources available to support consumption of another basic need (food). Counter to Biros et al.…”

“…Relative to the literature on food insecurity and medical expenditure, little is known about families' efforts to coordinate food and medical care spending. Biros et al (2005) examined data from 930 adult emergency department patients and found that 18% made explicit choices between food and medicine, including delaying the purchase of medicine to buy food or trading off between food and medicine purchases. Earlier, Kersey et al (1999) investigated hunger among 297 patients from the same hospital and reached similar conclusions.…”

“…Researchers have investigated the tradeoffs that families often make between medical care and food (e.g., Biros, Hoffman, & Resch, 2005; Kersey, Beran, McGovern, Biros, & Lurie, 1999). However, little research moves beyond convenience samples and cross‐sectional estimates to examine family‐level outcomes associated with acquiring food and medical care.…”

Food Insecurity is Associated with Hypoglycemia and Poor Diabetes Self-Management in a Low-Income Sample with Diabetes

“…Hyperglycemia may result from the inability to afford diabetes-appropriate foods, overconsumption during food adequacy (a behavior often observed among adults exposed to episodic food scarcity), reduced medication adherence, or lack of medication intensification by clinicians because of frequent hypoglycemic episodes or unpredictable dietary intake 6,14. Food-insecure patients are also more likely to have to choose between food and diabetes medication or supplies, a choice that is also likely to predispose patients to either hypoglycemia (if medications are taken instead of food) or hyperglycemia (if food is eaten instead of medications) 15,16. Our findings confirm the clinical impact of these difficult budget decisions.…”

Food Insecurity Among Households with Working-Age Adults with Disabilities

“…Lower quality diets and reduced intake of nutrients among members of food-insecure households (Bhattacharya et al, 2004;Dixon et al, 2001;Rose and Oliveira, 1997) may contribute to the poorer health and increased morbidity and mortality that have been associated with food insecurity (Siefert et al, 2004;Stuff et al, 2004;Vozoris and Tarasuk, 2003). The health effects associated with food insecurity may be even more detrimental for adults with disabling or chronic health conditions (Biros et al, 2005;Nelson et al, 1998;Nelson et al, 2001;Seligman et al, 2010;Seligman et al, 2012). Nutrition and human service agencies that are focused on the population of persons with disabilities and those with chronic disease recognize the importance of proper nutrition in treating chronic conditions (Association of Nutrition Service Agencies, 2006;New York State Department of Health, 2003;Wallace et al, 2007).…”