Food insecurity (FI) affects more than one in five American children and is increasingly addressed during pediatric primary care. Its relevance during subspecialty care, including in the treatment of chronic conditions like epilepsy, is largely unknown. This study sought to determine the FI prevalence among children with epilepsy and examine the relationship between FI and healthcare utilization, health-related quality-of-life (HR-QOL), and medication side effect control. This was a retrospective cohort study using electronic health record data from children, aged 2-17 years, seen for epilepsy management at an academic pediatric hospital. The primary predictor was household FI status, determined using a validated screening tool employed in the hospital's pediatric neurology clinics. The primary outcome was unplanned healthcare utilization in the 6 months following initial FI screen. Secondary outcomes were standardized, validated assessments of HR-QOL and epilepsy medication side effects. Nearly 14% of the 691 children seen in the clinics for epilepsy lived in food insecure households. The impact of FI on healthcare utilization varied by race. For Caucasians, healthcare utilization rates were significantly higher among food insecure individuals than food secure individuals (37 vs. 17%, p = 0.003). Among African Americans, healthcare utilization rates did not vary with food security status (p = 0.6). Children in food insecure households had lower HR-QOL (p < 0.0001) and higher medication side effects (p = 0.0005). FI is common among children with epilepsy and may influence adverse health outcomes. Further exploration into how FI and other social determinants influence management of and determine outcomes for chronic diseases is warranted.
Keywords: Child; Epilepsy; Food insecurity; Healthcare utilization; Quality of life.