UMMS-Baystate, Department of Emergency Medicine, Springfield, Massachusetts.
New York University School of Medicine, NYU Langone Health, Department of Population Health, New York, New York.
West J Emerg Med. 2021 Jul 14;22(4):911-918. doi: 10.5811/westjem.2021.3.50981.
Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients.
We completed survey questionnaires with randomly sampled adult patients from an urban public hospital ED (n = 2,312). We assessed food insecurity using four questions from the United States Department of Agriculture Household Food Security Survey. The primary independent variable was any food insecurity, defined as an affirmative response to any of the four items. Frequent ED use was defined as self-report of ≥4 ED visits in the past year. We examined the relationship between patient food insecurity and frequent ED use using bivariate and multivariable analyses and examined possible mediation by anxiety/depression and overall health status.
One-third (30.9%) of study participants reported frequent ED use, and half (50.8%) reported any food insecurity. Prevalence of food insecurity was higher among frequent vs. non-frequent ED users, 62.8% vs 45.4% (P <0.001). After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use (adjusted odds ratio 1.48, 95% confidence interval, 1.20-1.83). This observed association was partially attenuated when anxiety/depression and overall health status were added to models.
The high observed prevalence of food insecurity suggests that efforts to improve care of ED patients should assess and address this need. Further research is needed to assess whether addressing food insecurity may play an important role in efforts to reduce frequent ED use for some patients.
急诊科（ED）患者的食物不安全感水平高于平均水平。我们在一项随机抽取的 ED 患者样本中，研究了多种食物不安全感测量指标与频繁使用 ED 之间的关系。
我们对一家城市公立医院 ED 中随机抽取的成年患者（n=2312）完成了问卷调查。我们使用美国农业部家庭食物安全调查中的四个问题评估食物不安全感。主要的独立变量是任何食物不安全感，定义为对四个项目中的任何一个项目的肯定回答。频繁使用 ED 定义为自我报告过去一年中≥4 次 ED 就诊。我们使用双变量和多变量分析来研究患者食物不安全感与频繁使用 ED 之间的关系，并检查焦虑/抑郁和整体健康状况是否存在中介作用。
研究参与者中有三分之一（30.9%）报告了频繁使用 ED，有一半（50.8%）报告了任何食物不安全感。与非频繁使用 ED 者相比，频繁使用 ED 者的食物不安全感发生率更高，分别为 62.8%和 45.4%（P<0.001）。在控制了潜在的混杂因素后，食物不安全感与频繁使用 ED 仍然显著相关（调整后的优势比 1.48，95%置信区间，1.20-1.83）。当将焦虑/抑郁和整体健康状况纳入模型后，这种观察到的相关性有所减弱。
观察到的高食物不安全感发生率表明，改善 ED 患者护理的努力应评估和满足这一需求。需要进一步研究，以评估解决食物不安全感是否可能在减少某些患者频繁使用 ED 方面发挥重要作用。
