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

Alex Estrella,Joy Scheidell,Donna Castelblanco,Tod Mijanovich,Maria Khan,Kelly Doran,Lillian Gelberg,David Lee

doi:10.5811/westjem.2021.3.50981

Abstract

IntroductionEmergency 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.MethodsWe 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.ResultsOne-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.ConclusionThe 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.

Highlights

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
After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use

Summary

Introduction

A systematic review of the literature on social needs of emergency department (ED) patients found that prevalence of food insecurity is even higher among ED patients than among the general public.[12] Studies have found associations between food insecurity and more frequent ED use among specific groups including people experiencing homelessness,[13,14] and people with diabetes,[15] and among lowincome Americans more generally.[16] Food insecurity may lead to increased ED use due to its association with poor physical and mental health,[11] worse control of chronic diseases,[11,17,18] and medication non-adherence,[19] which are in turn associated with ED use.[20,21,22] We build on past literature by examining the association of food insecurity and frequent ED use among a large, random sample of ED patients not restricted to any particular subpopulation. We aimed to increase understanding of potential pathways between food insecurity and frequent ED use by examining whether poor physical and mental health might be mediators of this relationship

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