Food Security, Health, and Medication Expenditures of Emergency Department Patients

Abstract 

Background: In the United States, 35 million people live in food-insecure households. Although food insecurity and hunger are undesirable in their own right, they also are potential precursors to nutritional, health, and developmental problems. Study Objectives: To examine the prevalence of household food insecurity and its association with health problems and medication expenditures among Emergency Department (ED) patients. Methods: We conducted a cross-sectional study in four Boston-area EDs and enrolled consecutive adult patients during two 24-h periods at each site. Food security status was measured using the validated 18-item US Household Food Security Survey Module. Results: Overall, 66 (13%; 95% confidence interval [CI] 10–17%) of 520 ED patients screened positive for food insecurity. Among these 66 patients, 32 (48%; 95% CI 36–61%) reported food insecurity with hunger. Patients from food-insecure households differed from food-secure patients with respect to sociodemographic factors. Food-insecure patients were more likely than food-secure patients to report a variety of chronic and mental health problems (all p < 0.05), including obesity. Food-insecure patients, compared to food-secure patients, also were more likely (all p < 0.001) to put off paying for medication to have money for food (27% vs. 4%, respectively), to take medication less often because they couldn't afford more (32% vs. 4%, respectively), to report needing to make a choice between buying medication and food (27% vs. 2%, respectively), and to report getting sick because they couldn't afford to take medication (27% vs. 1%, respectively). Conclusions: ED patients from food-insecure households report more chronic and mental health problems, and difficulty purchasing medication.

Keywords: food insecurity, hunger, Emergency Department