Ujah Otobo I, LeCounte Erica S, Ogbu Chukwuemeka E, Kirby Russell S
College of Public Health, University of South Florida, Tampa, Florida, United States.
College of Public Health, University of South Florida, Tampa, Florida, United States.
Nutrition. 2023 Dec;116:112165. doi: 10.1016/j.nut.2023.112165. Epub 2023 Jul 20.
Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021.
We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security.
Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security.
This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.
尽管美国的粮食不安全危机日益严重，但关于粮食不安全对围产期（怀孕和产后）妇女未满足的医疗保健需求的影响的证据有限。本研究的目的是调查2019年至2021年美国围产期妇女粮食不安全与延迟或放弃医疗保健之间的关联。
我们使用2019年、2020年和2021年全国健康访谈调查的数据进行了汇总横断面分析。粮食安全状况按类型（高/边缘、低和极低）定义。进行描述性分析和多变量逻辑回归，并根据社会人口统计学和健康相关特征进行调整，以估计不同粮食安全类别之间总体和特定的延迟或放弃医疗保健（是或否）情况。
在1525名围产期妇女（加权后，N = 5580186）中，2019年至2021年期间，11%的美国围产期妇女在12个月内经历了次优粮食安全状况，其中5%经历了低粮食安全状况，5%经历了极低粮食安全状况。这包括6%（95%置信区间[CI]，5 - 8%）报告延迟开具医疗处方的人，6%（95%CI，5 - 8%）需要心理健康专业人员咨询或治疗但未接受的人，6%（5 - 8%）延迟接受心理健康专业人员咨询或治疗的人，8%（95%CI，6 - 10%）需要医疗护理但未接受的人，以及9%（95%CI，7 - 10%）延迟接受医疗护理的人。与粮食安全的围产期妇女相比，粮食安全状况低和极低的围产期妇女由于成本担忧更有可能延迟或放弃医疗保健。在针对易患因素、促成因素和基于需求的因素进行调整的多变量分析中，粮食安全状况低和极低的妇女比粮食安全状况边缘或高的妇女延迟或放弃医疗保健的风险更高。
本研究表明围产期妇女粮食不安全与与成本相关的未满足医疗保健需求之间存在正相关。需要未来的实证研究来评估针对粮食不安全的围产期医疗保健干预措施对减少与成本相关的医疗保健获取差距和改善围产期健康结果的影响。
