Food Insecurity, Neighborhood, and Health Care Utilization in Health System Adults

Abstract

To (1) explore relationships among food insecurity, neighborhood disadvantage, and health care utilization in adults from a single health system and (2) determine whether food insecurity and neighborhood disadvantage predict acute health care utilization within 90 days of hospital discharge. A retrospective, correlational design with a single cohort. Data were analyzed from health system administrative billing databases, electronic health records, and publicly available population databases. Multivariable negative binomial regression was performed to assess the association between factors of interest and acute health care utilization within 90 days of index hospital discharge. In 41,566 records, 1.45% (n = 601) of patients reported food insecurity. The mean (SD) Area Deprivation Index score was 54.4 (26), indicating that the majority of patients lived in disadvantaged neighborhoods. Patients with food insecurity were less likely to have a provider office visit (P < .001) but were expected to have 2.1 times greater acute health care utilization within 90 days (incidence rate ratio [IRR], 2.12; 95% CI, 1.90-2.37; P < .001) compared with those without food insecurity. Living in a disadvantaged neighborhood had a small effect on acute health care utilization (IRR, 1.12; 95% CI, 1.08-1.17; P < .001). When considering social determinants of health for health system patients, food insecurity was a stronger predictor of acute health care utilization than was neighborhood disadvantage. Identifying patients with food insecurity and targeting appropriate interventions to high-risk populations may improve provider follow-up and acute health care utilization.