Inpatient Food Insecurity Linked With Adverse Hospitalization Outcomes

Living in a food-secure household refers to having access to plenty of food to maintain a healthy and active lifestyle. According to a 2023 survey conducted by the United States Department of Agriculture, 86.5% of households in the US are food secure; however, this also means 13.5% (n = 18 million) of the nation’s households have experienced food insecurity at some point, signifying a 1 million–household increase compared with the year prior.¹

Inpatient food insecurity can also have a negative impact on caregivers | image Credit: udra11 - stock.adobe.com

External factors, such as hospitalization, can influence household food insecurity (HFI). Inpatient food insecurity (IFI) represents a subcategory of food insecurity that affects caregivers throughout a child’s hospitalization—regardless of their experience with HFI. This phenomenon remains a pertinent issue, as indicated by a recent study in JAMA Pediatrics that details the association between IFI, chances of readmission, and longer hospital stays.²

The authors pointed to the financial, social, and personal stressors brought about by pediatric hospitalizations, as well as findings of prior investigations that indicate the levels of fatigue, depression, and more that negatively impact caregivers. Among the literature, however, outcomes related to IFI remain understudied. To evaluate these consequences further, prospective data were gathered between May 2022 and December 2023 from a children’s hospital in North Carolina.

HFI was measured using the 2-item Hunger Vital Sign and a 3-item IFI screening tool developed by the researchers. Their tool assessed whether a caregiver did not eat as much as they felt they should have, abstained from eating while hungry, and/or skipped any meals throughout their child’s hospital stay—because they did not have enough money to buy food. Nurses verbally screened caregivers at least once over the course of the hospital stay and a “positive” screen for IFI was labeled if they answered yes to at least 1 item from their tool.

In total, 9325 caregiver hospital encounters were included, 8% of which (n = 718) were screened as IFI positive and 6% (n = 560) as HFI positive. These results were derived from 4224 female respondents and 5101 male respondents. Caregivers with positive IFI screening comprised 27% (n = 197) Black, 23% (n = 163) Hispanic, and 44% (n = 312) White respondents; 29% (n = 208) also reported belonging to another ethnicity or race. This analysis also revealed that English was the preferred language for 82% (n = 585) of these individuals. Additionally, 2% (n = 11) of respondents did not have insurance compared with 89% (n = 625) who had Medicaid.

Notably, among those who screened positive for IFI, 40% were deemed HFI negative. Longer lengths of stay were observed in participants with IFI (β coefficient, 2.41; 95% CI, 1.63-3.19 days), as well as an increased chance of readmission to the hospital within 30 days (OR, 1.77; 95% CI, 1.31-2.38) vs those who did not have IFI.

Among the limitations the researchers encountered, they listed the single-institution nature of their study, the lack of universal screening, and that their analysis was conducted during the COVID-19 pandemic, which uniquely affected rates of food insecurity.

“Developing interventions to reduce IFI may benefit hospitalized children and their families as well as hospital systems,” they concluded.

References

1. Food security in the U.S. USDA Economic Research Service. Updated September 4, 2024. Accessed September 16, 2024. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/

2. DeWitt LH, Montez K, Brown CL. Inpatient food insecurity and outcomes of pediatric hospitalizations. JAMA Pediatr. Published online September 16, 2024. doi:10.1001/jamapediatrics.2024.3092