Access to health care and food in children with food allergy

Abstract

Reduced access to health care and food in the United States is associated with poor health outcomes,1Jones R. Lin S. Munsie J.P. Radigan M. Hwang S.A. Racial/ethnic differences in asthma-related emergency department visits and hospitalizations among children with wheeze in Buffalo, New York.J Asthma. 2008; 45: 916-922Crossref PubMed Scopus (18) Google Scholar, 2Cook J.T. Frank D.A. Berkowitz C. Black M.M. Casey P.H. Cutts D.B. et al.Food insecurity is associated with adverse health outcomes among human infants and toddlers.J Nutr. 2004; 134: 1432-1438PubMed Google Scholar, 3Price J.H. Khubchandani J. McKinney M. Braun R. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.Biomed Res Int. 2013; 2013: 787616Crossref PubMed Google Scholar and facilitating access to providers, medications, and food has led to measured improvements in public health.4Fox P. Porter P.G. Lob S.H. Boer J.H. Rocha D.A. Adelson J.W. Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies.Pediatrics. 2007; 120: e902-e911Crossref PubMed Scopus (31) Google Scholar, 5Kowaleski-Jones L. Duncan G.J. Effects of participation in the WIC program on birthweight: evidence from the National Longitudinal Survey of Youth. Special Supplemental Nutrition Program for Women, Infants, and Children.Am J Public Health. 2002; 92: 799-804Crossref PubMed Google Scholar Food allergy is a common chronic condition affecting 4% to 8% of US children that is increasing in prevalence for unclear reasons.6Gupta R.S. Springston E.E. Warrier M.R. Smith B. Kumar R. Pongracic J. et al.The prevalence, severity, and distribution of childhood food allergy in the United States.Pediatrics. 2011; 128: e9-e17Crossref PubMed Scopus (999) Google Scholar, 7Keet C.A. Savage J.H. Seopaul S. Peng R.D. Wood R.A. Matsui E.C. Temporal trends and recent racial/ethnic disparities in pediatric food allergy in the US.Ann Allergy Asthma Immunol. 2014; ([in press])PubMed Google Scholar Whether patients with food allergy experience impaired access to health care and food is currently unknown. Minority populations share a significant burden of food allergy,7Keet C.A. Savage J.H. Seopaul S. Peng R.D. Wood R.A. Matsui E.C. Temporal trends and recent racial/ethnic disparities in pediatric food allergy in the US.Ann Allergy Asthma Immunol. 2014; ([in press])PubMed Google Scholar, 8Taylor-Black S. Wang J. The prevalence and characteristics of food allergy in urban minority children.Ann Allergy Asthma Immunol. 2012; 109: 431-437Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar and the rate of increase in food allergy in black children might be twice that in white children.7Keet C.A. Savage J.H. Seopaul S. Peng R.D. Wood R.A. Matsui E.C. Temporal trends and recent racial/ethnic disparities in pediatric food allergy in the US.Ann Allergy Asthma Immunol. 2014; ([in press])PubMed Google Scholar We were interested in whether subjects with food allergy report reduced access to health care and food and how this is associated with race/ethnicity because this could influence disease outcome. We examined data from the 2011 and 2012 National Health Interview Survey (NHIS), a household interview survey of the US population covering a range of health topics. In each household an adult answered questions about a randomly chosen child in the household. We considered a child to have food allergy if the responding adult answered yes to the following question: “During the past 12 months, has the sample child had any kind of food or digestive allergy?” We used the adult's responses to questions regarding the child's access to health care and the family's access to food as measures of access to health care and food. Access to food was defined by using the US Department of Agriculture (USDA)’s definition of “food security,” a measure of consistency of access to enough food for an active healthy life. Please see the supplementary text in this article's Online Repository at www.jacionline.org for additional information regarding the access measures, NHIS methodology, and variable definitions. Statistical analyses were performed with STATA 12.0 software (StataCorp, College Station, Tex). We used the χ2 test to determine whether subjects with and without food allergy differed by demographic and access factors. We used logistic regression to determine the association between race/ethnicity and access and adjusted for sex, age, family income, and education in a nested fashion. We incorporated survey weighting, sampling units, and strata in the primary χ2 analysis, but because subjects were not equally distributed among the strata, only survey weights were incorporated in the χ2 analysis stratified by race and in the logistic regression models. Complete data were available for 26,021 children from the combined 2011-2012 data set, of whom 1,351 (5.59%) reported food allergy. Of the children with food allergy, 54.8% were white, 17.1% were black/African American, 17.7% were Hispanic/Latino/Spanish, and 10.4% were classified as “other” (see Table E1 in this article's Online Repository at www.jacionline.org). Food allergy in the sample child was more common in families with a higher level of education and a higher household income, which is in line with previously reported demographic trends.6Gupta R.S. Springston E.E. Warrier M.R. Smith B. Kumar R. Pongracic J. et al.The prevalence, severity, and distribution of childhood food allergy in the United States.Pediatrics. 2011; 128: e9-e17Crossref PubMed Scopus (999) Google Scholar, 9McGowan E.C. Keet C.A. Prevalence of self-reported food allergy in the National Health and Nutrition Examination Survey (NHANES) 2007-2010.J Allergy Clin Immunol. 2013; 132: 1216-1219Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar The survey population was equally distributed between sexes and among age groups. Among children with food allergy, 20.95% were determined to have low food security, 33.53% reported having problems paying family medical bills, 4.47% reported not being able to afford needed prescriptions, 4.14% reported not being able to afford needed specialist care, 2.76% reported not being able to afford needed follow-up care, 2.45% reported having trouble finding a doctor to see the child, and 4.11% reported having no family member with health insurance (Fig 1, A, and see Table E1). With the exception of having family members without insurance, these values are all significantly higher than those for children without food allergy (P ≤ .05), and similar trends were observed when stratifying by race/ethnicity (see Table E2 in this article's Online Repository at www.jacionline.org). Compared with white children with food allergy, after adjusting for age and sex, black children with food allergy were significantly more likely to have low food security (odds ratio [OR], 3.31; 95% CI, 2.17-5.06), to have problems paying family medical bills (OR, 2.28; 95% CI, 1.55-3.35), and to be unable to afford needed prescriptions (OR, 3.44; 95% CI, 1.68-7.02; Fig 1, B, and Table I). Hispanic children with food allergy were more likely to have low food security (OR, 2.44; 95% CI, 1.61-3.70), to have problems paying family medical bills (OR, 1.56; 95% CI, 1.08-2.23), and to be unable to afford needed prescriptions (OR, 2.38; 95%, CI 1.13-5.03) and follow-up care (OR, 3.74; 95% CI, 1.70-8.24). Many of these associations were attenuated after further adjusting for income and parental education. However, even after incorporating these variables, black respondents with food allergy were significantly more likely to have low food security (OR, 2.15; 95% CI, 1.30-3.53), to have problems paying family medical bills (OR, 1.68; 95% CI, 1.09-2.59), and to have trouble affording prescriptions for the child (OR, 2.40; 95% CI, 1.14-5.05) and Hispanic respondents with food allergy were significantly more likely to have trouble affording follow-up care (OR, 3.02; 95% CI, 1.34-6.81; Table I) compared with white respondents with food allergy. There were no significant race/ethnicity differences in the ability to afford specialist care or difficulty finding a doctor to see the child. Black respondents with food allergy were more likely in all models to have any family member with health insurance. We next compared children with food allergy with those with other chronic medical conditions and found that children with food allergy have similar or greater difficulty with access to care and food as children with other chronic medical conditions, with similar racial/ethnic disparities as in the previous analysis (see Table E3 in this article's Online Repository at www.jacionline.org).Table IRacial/ethnic disparities in likelihood of poor food security and reduced health care access among children with food allergyCrude OR (95% CI)Model 1: Adjusted for child's age and sexModel 2: Model 1 adjusted for parental educationModel 3: Model 1 adjusted for income groupFull modelLow or very low food security White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American3.39 (2.21-5.19)3.31 (2.17-5.06)2.63 (1.64-4.22)2.20 (1.36-3.56)2.15 (1.30-3.53) Hispanic/Latino/Spanish2.45 (1.61-3.71)2.44 (1.61-3.70)1.63 (1.04-2.57)1.67 (1.07-2.62)1.47 (0.92-2.34) Other1.16 (0.62-2.14)1.17 (0.63-2.18)1.18 (0.63-2.23)1.20 (0.64-1.73)1.19 (0.62-2.27)Problems paying family medical bills White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American2.30 (1.57-3.38)2.28 (1.55-3.35)1.95 (1.29-2.93)1.69 (1.10-2.60)1.68 (1.09-2.59) Hispanic/Latino/Spanish1.57 (1.09-2.25)1.56 (1.08-2.23)1.21 (0.82-1.80)1.23 (0.83-1.83)1.18 (0.78-1.79) Other0.76 (0.48-1.20)0.76 (0.48-1.21)0.75 (0.47-1.21)0.81 (0.49-1.35)0.81 (0.49-1.35)Cannot afford prescriptions for child White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American3.34 (1.65-6.74)3.44 (1.68-7.02)3.13 (1.50-6.50)2.37 (1.13-4.98)2.40 (1.14-5.05) Hispanic/Latino/Spanish2.29 (1.07-4.89)2.38 (1.13-5.03)2.02 (0.88-4.61)1.76 (0.80-3.92)1.78 (0.77-4.10) Other0.23 (0.05-1.15)0.23 (0.05-1.16)0.24 (0.05-1.16)0.23 (0.05-1.17)0.23 (0.05-1.18)Cannot afford specialist care for child White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American0.44 (0.15-1.26)0.43 (0.15-1.25)0.39 (0.14-1.11)0.35 (0.12-0.96)0.34 (0.13-0.95) Hispanic/Latino/Spanish1.22 (0.51-2.91)1.25 (0.52-3.00)1.08 (0.46-2.57)1.08 (0.48-2.42)1.06 (0.47-2.42) Other0.44 (0.13-1.52)0.45 (0.13-1.56)0.45 (0.13-1.56)0.45 (0.13-1.60)0.45 (0.13-1.60)Cannot afford follow-up care for child White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American0.85 (0.30-2.40)0.85 (0.30-2.40)0.76 (0.26-2.17)0.59 (0.20-1.71)0.59 (0.20-1.72) Hispanic/Latino/Spanish3.65 (1.67-8.01)3.74 (1.70-8.24)3.18 (1.41-7.17)2.92 (1.30-6.56)3.02 (1.34-6.81) Other0.63 (0.11-3.68)0.64 (0.11-3.71)0.64 (0.11-3.69)0.65 (0.11-3.83)0.65 (0.11-3.84)Trouble finding a doctor to see child White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American1.00 (0.27-3.70)0.97 (0.26-3.56)0.80 (0.20-3.28)0.85 (0.20-3.56)0.82 (0.19-3.51) Hispanic/Latino/Spanish1.30 (0.46-3.64)1.29 (0.47-3.57)1.00 (0.35-2.89)1.19 (0.42-3.35)1.02 (0.35-2.97) Other2.06 (0.68-6.24)2.12 (0.71-6.36)2.12 (0.70-6.36)2.17 (0.71-6.60)2.16 (0.72-6.54)No insurance in family White1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference) Black/African American0.21 (0.05-0.92)0.23 (0.05-1.00)0.17 (0.04-0.77)0.15 (0.03-0.65)0.14 (0.03-0.63) Hispanic/Latino/Spanish1.66 (0.82-3.38)1.74 (0.85-3.57)1.16 (0.54-2.48)1.24 (0.56-2.73)1.10 (0.51-2.39) Other0.65 (0.19-2.20)0.63 (0.19-3.57)0.65 (0.19-2.19)0.62 (0.18-2.13)0.63 (0.18-2.16)Values in boldface are statistically significant. Open table in a new tab Values in boldface are statistically significant. In this large national survey we examined access to health care and food among subjects with food allergy, a chronic disease increasing in prevalence. We found that compared with subjects without food allergy, subjects with food allergy are significantly more likely to report difficulty with access to care and food. Furthermore, parents of nonwhite children with food allergy were significantly more likely to report difficulty affording medical care and medications and low food security compared with parents of white children with food allergy. Not surprisingly, many of these associations were attenuated when we included parental income and education in the analysis. However, we were surprised that even after adjusting for income and education, black respondents with food allergy were significantly more likely to report low food security and trouble affording prescriptions and Hispanic respondents with food allergy were significantly more likely to report trouble affording follow-up care compared with white respondents. Although it might be unsurprising that families of children with food allergies report more trouble accessing health care than families of children without food allergy, we did find that families of children with food allergy report at least as much, if not more, trouble accessing health care as families of children with other chronic diseases (see Table E3 and the supplemental text in this article's Online Repository). Our results suggest there might be a barrier to accessing health care and food in children with food allergy, particularly among nonwhite children. Poor access to health care and food might increase morbidity, especially among minority children, by imposing poor nutrition and delayed treatment for allergic reactions. Associations drawn from cross-sectional studies are only a first step in understanding the association between food allergy and access to care. Our study is limited by the use of parental report of food or digestive allergy within the last year. This might overestimate or underestimate food allergy prevalence, and further validation studies are needed to perform population-based studies of food allergy. However, parent-reported food allergy prevalence in our sample falls within the range of previously reported estimates and has been used in many epidemiologic studies of food allergy.6Gupta R.S. Springston E.E. Warrier M.R. Smith B. Kumar R. Pongracic J. et al.The prevalence, severity, and distribution of childhood food allergy in the United States.Pediatrics. 2011; 128: e9-e17Crossref PubMed Scopus (999) Google Scholar, 7Keet C.A. Savage J.H. Seopaul S. Peng R.D. Wood R.A. Matsui E.C. Temporal trends and recent racial/ethnic disparities in pediatric food allergy in the US.Ann Allergy Asthma Immunol. 2014; ([in press])PubMed Google Scholar, 9McGowan E.C. Keet C.A. Prevalence of self-reported food allergy in the National Health and Nutrition Examination Survey (NHANES) 2007-2010.J Allergy Clin Immunol. 2013; 132: 1216-1219Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar Our cross-sectional study is also limited by the possibility of reverse causation in that decreased access to health care and food might increase the likelihood of self-report of food allergy. However, we incorporated potentially important socioeconomic confounders, such as income and education, into our analyses, making this effect less likely. We were also limited by our inability to incorporate the full sampling design into our analysis because of the distribution of subjects within strata. Therefore our estimates are not necessarily nationally representative. However, this study is notable because it is the first to examine access to care among patients with food allergy and includes more than 1000 subjects with parent-reported food allergy, nearly 50% of whom are nonwhite. In summary, we have demonstrated that subjects with food allergy report difficulty with access to medical care and food and that there are significant disparities in access associated with race/ethnicity. We were surprised that many of these disparities persisted after adjusting for income and education, which might be explained by sociocultural factors and needs further investigation. Given the increasing burden of food allergy, particularly among children of black/African American ethnicity, our results might have significant public health implications. Further study is necessary to determine whether impaired access to care in patients with food allergy is associated with increased morbidity and whether improvements in access can improve disease outcome, as has been shown for patients with other allergic diseases, such as asthma.4Fox P. Porter P.G. Lob S.H. Boer J.H. Rocha D.A. Adelson J.W. Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies.Pediatrics. 2007; 120: e902-e911Crossref PubMed Scopus (31) Google Scholar Access to health care is assessed with questions regarding a subject's ability to afford needed medications, having a usual source of care, and use of nonemergency physician visits. There is no standardized questionnaire to assess health care access. Reduced access to care has been associated with morbidity in patients with chronic diseases, including childhood asthma.E1Akinbami L.J. Moorman J.E. Garbe P.L. Sondik E.J. Status of childhood asthma in the United States, 1980-2007.Pediatrics. 2009; 123: S131-S145Crossref PubMed Scopus (668) Google Scholar, E2Mansour M.E. Lanphear B.P. DeWitt T.G. Barriers to asthma care in urban children: parent perspectives.Pediatrics. 2000; 106: 512-519Crossref PubMed Scopus (248) Google Scholar Asthma morbidity, which is often measured by an increase in emergency department/urgent care visits and hospitalization rates, is greater in inner-city minority children, who also demonstrate reduced use of nonemergency follow-up care.E1Akinbami L.J. Moorman J.E. Garbe P.L. Sondik E.J. Status of childhood asthma in the United States, 1980-2007.Pediatrics. 2009; 123: S131-S145Crossref PubMed Scopus (668) Google Scholar, E3Price J.H. Khubchandani J. McKinney M. Braun R. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.Biomed Res Int. 2013; 2013: 787616Crossref PubMed Scopus (84) Google Scholar, E4Jones R. Lin S. Munsie J.P. Radigan M. Hwang S.A. Racial/ethnic differences in asthma-related emergency department visits and hospitalizations among children with wheeze in Buffalo, New York.J Asthma. 2008; 45: 916-922Crossref PubMed Scopus (34) Google Scholar Programs targeted at improving access to health care through community health centers and schools have been successful at improving asthma outcomes.E5Fox P. Porter P.G. Lob S.H. Boer J.H. Rocha D.A. Adelson J.W. Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies.Pediatrics. 2007; 120: e902-e911Crossref PubMed Scopus (67) Google Scholar, E6Levy M. Heffner B. Steeart T. Beeman G. The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma.J Sch Health. 2006; 76: 320-324Crossref PubMed Scopus (65) Google Scholar To our knowledge, access to health care has not been previously evaluated in food allergy. Access to food is measured by “family food security,” which is defined by the USDA as “access by all people at all times to enough food for an active, healthy life” and is determined based on answers to a food security survey administered to families consisting of questions about the conditions and behaviors of the family as a whole, adults, and children related to their ability to meet basic needs for food.E7Coleman-Jensen A. Nord M. Singh A. Household food security in the United States in 2012, ERR-155. US Department of Agriculture, Economic Research Service, Washington (DC)2013Google Scholar Food insecurity is independently associated with delays in seeking care and obtaining medications, as well as increased urgent care visitsE8Kushel M.B. Gupta R. Gee L. Haas J.S. Housing instability and food insecurity as barriers to health care among low-income Americans.J Gen Intern Med. 2006; 21: 71-77Crossref PubMed Scopus (468) Google Scholar and in children has been associated with poor general health and hospitalizations.E9Cook J.T. Frank D.T. Berkowitz C. Black M.M. Casey P.H. Cutts D.B. et al.Food insecurity is associated with adverse health outcomes among human infants and toddlers.J Nutr. 2004; 134: 1432-1438PubMed Google Scholar Food assistance programs, such as the Special Supplementation Nutrition Program for Women, Infants, and Children, have demonstrated improved health outcomes.E10Kowaleski-Jones L. Duncan G.J. Effects of participation in the WIC program on birthweight: evidence from the National Longitudinal Survey of Youth. Special Supplemental Nutrition Program for Women, Infants, and Children.Am J Public Health. 2002; 92: 799-804Crossref PubMed Scopus (85) Google Scholar Appropriate nutrition within the limits of restricted diets is especially important for children with food allergiesE11Mehta H. Groetch M. Wang J. Growth and nutritional concerns in children with food allergy.Curr Opin Allergy Clin Immunol. 2013; 13: 275-279PubMed Google Scholar; however, the incidence of food insecurity and implications for morbidity in this population have not been previously examined. Data were obtained from the NHIS, which is accessed through the Centers for Disease Control and Prevention. The NHIS is conducted annually by the National Center for Health Statistics. Households are selected as part of a probability sample representative of the noninstitutionalized US population, and a sample adult is chosen to answer questions regarding the health of the family and of one child randomly chosen from those in each household.E12National Center for Health Statistics. National Health Interview Survey—questionnaires, datasets, and related documentation 1997 to the present. 2011-2012 June 27, 2013. Available at: http://www.cdc.gov/nchs/nhis/quest_data_related_1997_forward.htm. Accessed August 2013.Google Scholar We used answers to the following questions as measures of food and health care access:•In the past 12 months, did you or anyone in the family have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care.•During the past 12 months, was there any time when the sample child needed any of the following but did not get it because you could not afford it?A.Prescription medicinesB.To see a specialistC.Follow-up care•During the past 12 months, did you have any trouble finding a general doctor or provider who would see the sample child?•Are you/is anyone in the family covered by any kind of health insurance or some other kind of health care plan?•Family food security, which is defined as “access by all people at all times to enough food for an active, healthy life” was determined according to the USDA's guidelinesE7 and was dichotomized as “secure” or “not secure.” Race and ethnicity were defined by self-report and were categorized as non-Hispanic white, non-Hispanic black/African American, Hispanic/Spanish/Latino, and non-Hispanic other. Income and level of education of the most educated adult in the household were grouped, as shown in Table E1. These were incorporated into the model as dummy variables. To contextualize our results, we compared access to health care and food among children with food allergy with access among children with other chronic medical conditions that also require medications, specialist care, and follow-up care. We included children with cystic fibrosis, sickle cell anemia, diabetes, arthritis, congenital heart disease, other heart conditions, asthma, or anemia in this group. Respondents who answered yes to any of the following questions and no to “During the past 12 months, has the sample child had any kind of food or digestive allergy?” were included in the “other chronic medical conditions” group.•Looking at this list, has a doctor or health professional ever told you that the sample child had any of these conditions?A.Cystic fibrosisB.Sickle cell anemiaC.DiabetesD.ArthritisE.Congenital heart diseaseF.Other heart condition•Has a doctor or other health professional ever told you that the sample child had asthma? Also, does the sample child still have asthma?•During the past 12 months, has the sample child had anemia? Respondents who answered yes to the question “During the past 12 months, has the sample child had any kind of food or digestive allergy?” were included in the food allergy group, including respondents who answered yes to having food allergy and another chronic condition. We used logistic regression to determine the odds of reporting poor access to health care and food for children with food allergy compared with children with the above medical conditions and adjusted for sex, age, family income, and education. Because subjects were not equally distributed among the strata, only survey weights were incorporated in the logistic regression model. The results are shown in Table E3.Table E1Sociodemographic characteristics and reported access to health care and food among children with and without food allergyFood allergyYes (n = 1,351)No (n = 24,670)P valueOverall5.59%94.41%Sex.80 Male51.56%51.10% Female48.44%48.90%Age (y).20 0-532.02%33.78% 6-1136.14%33.13% 12-1731.83%33.09%Ethnicity<.001 White54.83%53.51% Black/African American17.07%13.57% Hispanic/Latino/Spanish17.72%24.26% Other10.39%8.66%Annual family income.006 <$35,00035.76%33.53% $35,000-$74,99925.78%30.75% ≥$75,00038.46%35.72%Highest level of parental education<.001 High school diploma or less23.08%30.35% Some college or Associate's degree34.86%33.68% Bachelor's degree or higher42.06%35.97%Food security<.001 Secure79.05%83.91% Not secure20.95%16.09%Problems paying family medical bills33.53%22.64%<.001Cannot afford prescriptions for child4.47%2.13%<.001Cannot afford specialist care for child4.14%1.30%<.001Cannot afford follow-up care for child2.76%1.19%<.001Trouble finding a doctor to see child2.45%1.58%.05No insurance in family4.11%3.89%.77 Open table in a new tab Table E2Reported access to health care and food stratified by race/ethnicityWhiteBlack/African AmericanHispanic/Latino/SpanishOtherNot allergic to foodAllergic to foodP valueNot allergic to foodAllergic to foodP valueNot allergic to foodAllergic to foodP valueNot allergic to foodAllergic to foodP valueLow or very low food security11.82%14.5%.1023.03%36.25%<.00122.56%28.42%.0713.51%17.16%.34Problems paying family medical bills21.41%28.41%<.00126.28%48.86%<.00124.56%39.51%<.00119.16%25.03%.13Cannot afford prescriptions for child1.41%3.01%.0042.55%9.38%<.0013.58%6.45%.051.89%0.76%.23Cannot afford specialist care for child0.96%4.66%<.0011.28%2.09%.302.14%5.68%.0041.05%2.19%.22Cannot afford follow-up care for child0.75%1.95%.0021.28%1.71%.532.18%7.10%<.0010.97%1.34%.72Trouble finding a doctor to see child1.36%2.11%.201.37%2.06%.482.06%2.72%.491.96%4.43%.08No insurance in family3.06%4.34%.192.24%0.95%.216.33%7.11%.624.84%3.00%.38Values in boldface are statistically significant. Open table in a new tab Table E3Likelihood of reduced access to health care and food among children with food allergy compared with children with other chronic medical conditions both overall and stratified by race/ethnicity∗Analyses were adjusted for age, sex, household income, and parental education and for race in the overall analysis. There were 2,645 children with chronic medical conditions other than food allergy (white, 982; black/African American, 650; Hispanic/Latino/Spanish, 764; and other, 249) and 1351 children with food allergy (white, 626; black/African American, 239; Hispanic/Latino/Spanish, 305; and other, 181). Other chronic medical conditions include cystic fibrosis, sickle cell anemia, diabetes, arthritis, congenital heart disease, other heart conditions, asthma, and anemia.OverallWhiteBlack/African AmericanHispanic/Latino/SpanishOtherProblems paying family medical bills1.36 (1.12-1.65)1.10 (0.81-1.48)2.44 (1.64-3.61)1.44 (1.01-2.06)1.05 (0.55-1.97)Cannot afford prescriptions for child1.04 (0.72-1.51)0.81 (0.43-1.51)2.28 (1.16-4.47)0.83 (0.41-1.68)0.45 (0.04-4.83)Cannot afford specialist care for child1.94 (1.16-3.23)2.05 (0.95-4.42)0.83 (0.27-2.56)2.59 (1.00-6.70)1.83 (0.35-9.69)Cannot afford follow-up care for child1.69 (1.03-2.75)1.46 (0.65-3.28)0.97 (0.28-3.36)2.27 (1.10-4.69)1.82 (0.10-31.85)Trouble finding a doctor to see child1.12 (0.67-2.88)1.78 (0.71-4.46)0.78 (0.24-2.55)0.56 (0.22-1.43)8.20 (1.41-47.84)No insurance in family2.32 (1.45-3.73)2.67 (1.22-5.82)0.56 (0.06-5.21)2.12 (1.10-4.09)9.9 (0.83-20.13)Low or very low food security1.15 (0.92-1.44)1.04 (0.70-1.53)1.52 (1.01-2.29)1.18 (0.79-1.77)0.78 (0.39-1.55)Values in boldface are statistically significant.∗ Analyses were adjusted for age, sex, household income, and parental education and for race in the overall analysis. There were 2,645 children with chronic medical conditions other than food allergy (white, 982; black/African American, 650; Hispanic/Latino/Spanish, 764; and other, 249) and 1351 children with food allergy (white, 626; black/African American, 239; Hispanic/Latino/Spanish, 305; and other, 181). Other chronic medical conditions include cystic fibrosis, sickle cell anemia, diabetes, arthritis, congenital heart disease, other heart conditions, asthma, and anemia. Open table in a new tab Values in boldface are statistically significant. Values in boldface are statistically significant.