Exploring associations of inpatient food insecurity and pediatric hospitalizations | Image Credit: © Viktoriia - © Viktoriia - stock.adobe.com.

Background

Previous research has associated poor health outcomes and increased health care use with household food insecurity (HFI), which can be dependent on context and environmental stressors, such as hospitalization.¹

In a research letter published in JAMA Pediatrics, authors noted that inpatient food insecurity (IFI) is a phenomenon identified as food insecurity (FI) that caregivers experience during their child's hospitalization. Experienced stressors that have previously been associated with pediatric hospitalizations include personal, financial, and social difficulties.¹

"Prior evaluation of IFI’s consequences revealed caregiver depression, fatigue, and potential distrust of health care practitioners," wrote the investigative team of Leila H. DeWitt, DO, MA; Kimberly Montez, MD, MPH; and Callie L. Brown, MD, MPH. "However, little is known about the implications of IFI for hospital outcomes. In this study, we assessed the association of IFI with length of stay (LOS) and readmission," the authors added.¹

Study details and results

The investigators used prospective data captured at a children's hospital with an academic medical center in North Carolina from May 2022 to December 2023.¹ HFI was measured using the 2-item Hunger Vital Sign, a 2-question food insecurity screening tool. Households are identified as being at risk for food insecurity if they answer "often true" to either or both of the following statements:²

• "Within the past 12 months we worried whether our food would run out before we got money to buy more.”
• “ Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”

With this, the investigators created a 3-item IFI screening tool that identified whether:

• The caregiver ate less than they felt they should
• Felt hungry but did not eat
• Skipped meals during their child's hospitalization due to lack of money for food

A positive screen was defined as a "yes" response to at least 1 of the 3 items. Hospital nursing staffs were asked to screen caregivers verbally at least once during the hospitalization and document results. Those with IFI were provided with food during admission.¹

In all, there were 9325 hospital encounters, of which 718 screened positive for IFI and 560 for HFI. Race and ethnicity were used as a proxy for experiences with structural racism. Caregivers with IFI included:¹

• 197 Black individuals (27%)
• 163 Hispanic individuals (23%)
• 312 (44%) individuals
• 208 individuals as other race (29%)

There were 585 caregivers who preferred English language. A total of 625 had Medicaid or no insurance. Of those with IFI, 40% screened negative for HFI.¹

IFI participants had a longer LOS (β coefficient, 2.41; 95% CI, 1.63-3.19 days) as well as increased odds of readmission within a 30-day period (odds ratio, 1.77; 95% CI, 1.31-2.38) compared to those without IFI, according to findings.¹

"As 40% of caregivers with IFI did not have HFI, screening for HFI alone may miss many families experiencing FI during their child’s hospitalization," said DeWitt and colleagues, who noted screening for IFI is warranted to provide appropriate support both nutritionally and socially.¹

The authors pointed out limitations from the study, which included data was from a single institution and the lack of universal screening. The study took place amid the COVID-19 pandemic, when FI rates were lower than prior to the pandemic and after.¹

Conclusion

"Further research should evaluate the implications of IFI for child health outcomes and etiologies for increased LOS and readmission rate. For caregivers experiencing IFI, increased LOS and odds of readmission likely precede challenging social circumstances associated with hospitalization, such as foregone work time and transportation difficulties," wrote the investigators.

References:

1. 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

2. What is the Hunger Vital Sign. Children's HealthWatch. Accessed September 19, 2024. https://childrenshealthwatch.org/public-policy/hunger-vital-sign/