251 Food Insecurity and Frequent Emergency Department Use

Abstract

Emergency department (ED) patients are disproportionately impacted by poverty and other social stressors. Research in selected populations has found food insecurity to be an important social determinant of health. While studies have shown that ED patients are more likely to be food insecure than the general population, little research has examined the relationship between food insecurity and frequency of ED use. We surveyed a random sample of ED patients at an urban, public hospital from November 2016-April 2017. Eligible patients were: ≥18 years old, clinically stable, not arrested or incarcerated, spoke English or Spanish and had not already participated in the survey. RAs verbally administered a 20-40 minute survey covering a wide range of health-related topics. Frequent ED use was defined as self-report of ≥4 ED visits in the past 12 months, including the current visit. Food insecurity was defined as responding positively to any of four food insecurity questions from the U.S. Department of Agriculture Adult Food Security Module: running out of food before getting money to buy more, food not lasting until having money to buy more, being unable to afford balanced meals, and eating less than they felt they should have due to financial concerns, all in the past 12 months. We performed statistical testing for bivariate relationships between food insecurity and frequent ED use with chi-square and Kruskal-Wallis tests. Multivariable logistic regression controlling for age, race/ethnicity, sex, and self-reported overall health was conducted to better assess the effect of food insecurity on frequent ED use. 1157 of 1412 eligible patients participated (81.9%). Mean age was 48 years, 41.7% were female, 53.5% were Hispanic/Latino, 22.1% were white, and 29.0% were black. One-third (31.8%) reported frequent ED use and 51.1% reported food insecurity. Rates of food insecurity were higher among frequent vs. non-frequent ED users, 60.5% vs. 46.7% (p<.001). Differences by question were: 47.1% vs. 35.4% worried about food running out (p<.001), 46.5% vs. 30.4% food not lasting (p<.001), 49.6% vs. 32.9% being unable to afford balanced meals (p<.001), and 38.2% vs. 22.6% eating less than they felt they should (p<.001). In multivariable logistic regression analyses, food insecurity continued to be a significant predictor of frequent ED use. ED patients in this study had high rates of food insecurity. Food insecurity was significantly associated with frequent ED use. Future research will include analysis of the pathways through which food insecurity may be related to frequent ED use and will examine whether the relationship between food insecurity and ED use is stronger for patients with certain “food-sensitive” illnesses (eg, diabetes). These early findings suggest that food insecurity may be important to consider in studies of and interventions for frequent ED users.