Ghani Farheen, Wang Hao, Manning Sydney E, Sambamoorthi Usha
Department of Pharmacotherapy, College of Pharmacy University of North Texas Health Science Center Fort Worth Texas USA.
Department of Emergency Medicine JPS Health Network Fort Worth Texas USA.
Health Sci Rep. 2023 Feb 20;6(2):e1123. doi: 10.1002/hsr2.1123. eCollection 2023 Feb.
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.
We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years ( = 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.
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%, < 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, = 0.007) compared with those with food security and chronic conditions.
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.
粮食不安全与慢性病状况相结合是急诊科（ED）就诊的一个风险因素，这是医疗质量差的一个指标。然而，在患有慢性病的学龄儿童中，这种关联并不确定。因此，我们旨在确定美国学龄儿童中粮食不安全、慢性病与急诊科就诊之间的关联。
我们分析了2017年医疗支出面板调查（MEPS）中6至17岁儿童（n = 5518）的数据。MEPS数据由医疗保健研究与质量局（AHRQ）以电子方式发布。我们根据粮食安全状况和慢性病情况将学龄儿童分为四组：1）粮食不安全且患有慢性病；2）粮食安全且无慢性病；3）粮食不安全且无慢性病；4）粮食安全且无慢性病。我们使用计数数据模型，特别是多变量泊松回归，在调整了儿童的年龄、性别、种族和族裔、家庭收入、保险覆盖范围、肥胖和地理区域后，使用发病率比（IRR）比较这四组儿童的急诊科就诊情况。我们使用SAS 9.4和STATA 14.2进行所有数据分析。
在最终分析中，有5518名未加权的学龄儿童，代表了50479419名加权的学龄儿童。总体而言，6.0%的儿童粮食不安全且患有慢性病。这些儿童的急诊科就诊率（19.7%）高于其他三组（13.3%、8.8%和7.2%，P < 0.001）。与粮食安全且患有慢性病的儿童相比，粮食不安全且患有慢性病的学龄儿童急诊科就诊的调整后IRR为1.90（95%置信区间1.20 - 3.01，P = 0.007）。
每16名学龄儿童中就有1名同时存在粮食不安全和慢性病。在患有慢性病的情况下，粮食不安全与频繁的急诊科就诊呈正相关。因此，解决粮食不安全问题可能会降低急诊科就诊的风险。
