Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Anthropology, Dartmouth College, Hanover, NH, USA.
Clin Orthop Relat Res. 2023 May 1;481(5):849-858. doi: 10.1097/CORR.0000000000002514. Epub 2023 Jan 13.
The economic burden of traumatic injuries forces families into difficult tradeoffs between healthcare and nutrition, particularly among those with a low income. However, the epidemiology of food insecurity among individuals reporting having experienced fractures is not well understood.
QUESTIONS/PURPOSES: (1) Do individuals in the National Health Interview Survey reporting having experienced fractures also report food insecurity more frequently than individuals in the general population? (2) Are specific factors associated with a higher risk of food insecurity in patients with fractures?
This retrospective, cross-sectional analysis of the National Health Interview Survey was conducted to identify patients who reported a fracture within 3 months before survey completion. The National Health Interview Survey is an annual serial, cross-sectional survey administered by the United States Centers for Disease Control, involving approximately 90,000 individuals across 35,000 American households. The survey is designed to be generalizable to the civilian, noninstitutionalized United States population and is therefore well suited to evaluate longitudinal trends in physical, economic, and psychosocial health factors nationwide. We analyzed data from 2011 to 2017 and identified 1399 individuals who reported sustaining a fracture during the 3 months preceding their survey response. Among these patients, 27% (384 of 1399) were older than 65 years, 77% (1074) were White, 57% (796) were women, and 14% (191) were uninsured. A raw score compiled from 10 food security questions developed by the United States Department of Agriculture was used to determine the odds of 30-day food insecurity for each patient. A multivariate logistic regression analysis was performed to determine factors associated with food insecurity among patients reporting fractures . In the overall sample of National Health Interview Survey respondents, approximately 0.6% (1399 of 239,168) reported a fracture.
Overall, 17% (241 of 1399) of individuals reporting broken bones or fractures in the National Health Interview Survey also reported food insecurity. Individuals reporting fractures were more likely to report food insecurity if they also were aged between 45 and 64 years (adjusted odds ratio 4.0 [95% confidence interval 2.1 to 7.6]; p < 0.001), had a household income below USD 49,716 (200% of the federal poverty level) per year (adjusted OR 3.1 [95% CI 1.9 to 5.1]; p < 0.001), were current tobacco smokers (adjusted OR 2.8 [95% CI 1.6 to 5.1]; p < 0.001), and were of Black race (adjusted OR 1.9 [95% CI 1.1 to 3.4]; p = 0.02).
Among patients with fractures, food insecurity screening and routine nutritional assessments may help to direct financially vulnerable patients toward available community resources. Such screening programs may improve adherence to nutritional recommendations in the trauma recovery period and improve the physiologic environment for adequate soft tissue and bone healing. Future research may benefit from the inclusion of clinical nutritional data, a broader representation of high-energy injuries, and a prospective study design to evaluate cost-efficient avenues for food insecurity interventions in the context of locally available social services networks.
Level III, prognostic study.
创伤性损伤的经济负担迫使家庭在医疗保健和营养之间做出艰难的权衡，尤其是那些收入较低的家庭。然而，报告经历过骨折的个体中食物不安全的流行病学情况尚不清楚。
问题/目的：（1）在全国健康访谈调查中报告经历过骨折的个体是否比一般人群更频繁地报告食物不安全？（2）是否存在与骨折患者食物不安全风险较高相关的特定因素？
本研究回顾性分析了全国健康访谈调查，以确定在调查完成前 3 个月内报告骨折的患者。全国健康访谈调查是由美国疾病控制中心进行的年度连续横断面调查，涉及美国 35000 个家庭中的约 90000 个人。该调查旨在推广到美国平民非机构化人群，因此非常适合评估全国范围内身体、经济和心理社会健康因素的纵向趋势。我们分析了 2011 年至 2017 年的数据，并确定了 1399 名在调查前 3 个月内报告骨折的患者。这些患者中，27%（1399 名中的 384 名）年龄大于 65 岁，77%（1074 名中的 77%）为白人，57%（796 名中的 57%）为女性，14%（191 名中的 14%）没有保险。美国农业部开发的 10 个粮食安全问题的原始分数用于确定每位患者 30 天食物不安全的几率。采用多变量逻辑回归分析确定报告骨折患者中与食物不安全相关的因素。在全国健康访谈调查应答者的总体样本中，约 0.6%（239168 名中的 1399 名）报告骨折。
总体而言，报告在全国健康访谈调查中骨折或骨折的个体中有 17%（1399 名中的 241 名）报告食物不安全。如果报告骨折的个体年龄在 45 至 64 岁之间（调整后的优势比 4.0 [95%置信区间 2.1 至 7.6]；p < 0.001）、家庭收入低于每年 49716 美元（联邦贫困线的 200%）（调整后的比值比 3.1 [95%置信区间 1.9 至 5.1]；p < 0.001）、目前吸烟（调整后的比值比 2.8 [95%置信区间 1.6 至 5.1]；p < 0.001）或为黑人（调整后的比值比 1.9 [95%置信区间 1.1 至 3.4]；p = 0.02），则更有可能报告食物不安全。
在骨折患者中，食物不安全筛查和常规营养评估可能有助于指导经济脆弱的患者获得可用的社区资源。这种筛查计划可能会改善创伤康复期间对营养建议的依从性，并改善充足软组织和骨骼愈合的生理环境。未来的研究可能受益于纳入临床营养数据、更广泛的高能量损伤代表性以及前瞻性研究设计，以评估在当地现有社会服务网络背景下进行食物不安全干预的具有成本效益的途径。
三级，预后研究。
