Interactive association of chronic illness and food insecurity with emergency department utilization among school-age children in the United States: A cross-sectional study

Farheen Ghani; Hao Wang; Sydney E Manning; Usha Sambamoorthi

doi:10.1002/hsr2.1123

Interactive association of chronic illness and food insecurity with emergency department utilization among school-age children in the United States: A cross-sectional study

Health Sci Rep. 2023 Feb 20;6(2):e1123. doi: 10.1002/hsr2.1123. eCollection 2023 Feb.

Authors

Farheen Ghani¹, Hao Wang², Sydney E Manning³, Usha Sambamoorthi¹

Affiliations

¹ Department of Pharmacotherapy, College of Pharmacy University of North Texas Health Science Center Fort Worth Texas USA.
² Department of Emergency Medicine JPS Health Network Fort Worth Texas USA.
³ AcornAI Medidata Solution Boston Massachusetts USA.

Abstract

Background and aims: Food insecurity combined with chronic disease conditions is a risk factor for Emergency Department (ED) utilization, an indicator of poor quality of care. However, such an association is not certain among school-age children with chronic conditions. Therefore, we aim to determine the association of food insecurity, chronic conditions, and ED utilization among school-age children in the United States.

Methods: We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years (N = 5518). MEPS data was released electronically by the Agency for Healthcare Research and Quality (AHRQ). We identified four groups of school-age children based on the presence of food security and chronic conditions: 1) with food insecurity and chronic conditions; 2) no food insecurity and chronic conditions; 3) with food insecurity and no chronic conditions; and 4) no food insecurity and no chronic conditions. We compared ED utilization among these four groups using incidence rate ratios (IRR) after adjusting children's age, sex, race and ethnicity, household income, insurance coverage, obesity, and geographic region using count data model, specifically multivariable Poison regression. We used SAS 9.4 and STATA 14.2 for all the data analyses.

Results: There were unweighted 5518 school-age children who represented weighted 50,479,419 school-age children in the final analysis. Overall, 6.0% had food insecurity with chronic conditions. These children had higher ED utilization (19.7%) than the other three groups (13.3%, 8.8%, and 7.2%, p < 0.001). The adjusted IRR of ED utilization among school-age children with food insecurity and chronic conditions was 1.90 (95% confidence interval 1.20-3.01, p = 0.007) compared with those with food security and chronic conditions.

Conclusion: One in 16 school-age children has both food insecurity and chronic conditions. Food insecurity was positively associated with frequent ED visits in the presence of chronic conditions. Therefore, addressing food insecurity may reduce the risk of ED visits.

Keywords: ED utilization; MEPS; chronic conditions; food insecurity; school‐age population.