Food insecurity associated with increased pediatric hospital stays and odds of readmission

Food insecurity, which is the limited or uncertain availability of nutritionally adequate and safe food, is associated with poor health outcomes and the increased need to use health care services. According to the U.S. Department of Agriculture Economic Research Service, food insecurity impacts 10.2% of U.S. households. In families with children in the home, food insecurity is even higher, at 12.5%.

A new study by researchers at Wake Forest University School of Medicine shows that inpatient food insecurity, experienced by caregivers during their child's hospitalization, is associated with not only longer hospital admissions but also significantly increased odds of readmission.

The findings appear online in JAMA Pediatrics.

"A child's hospitalization can generate financial, social and personal stressors for caregivers," said Leila H. DeWitt, D.O., assistant professor of pediatrics at Wake Forest University School of Medicine and the study's corresponding author. "But little is known about how inpatient food insecurity can impact hospital outcomes."

For the study, the research team collected data from 9,325 hospital encounters from May 2022 and December 2023 at Atrium Health Levine Children's Brenner Children's Hospital and conducted a three-question survey of caregivers to determine if, at any point during their child's hospitalization, they ate less than they felt they should, felt hungry but did not yet or skipped meals, due to lack of money for food.

A "yes" response to one or more of the questions resulted in a positive screen for inpatient food insecurity. Caregivers who tested positive were also provided meals during admission.

In addition to screening for inpatient food insecurity, caregivers were also screened for household food insecurity via a commonly used two-question screening tool, the Hunger Vital Sign.

The research team found that 8% of caregivers were positive for inpatient food insecurity, and 6% were positive for household food insecurity. Almost half (40%) of those who screened positive for inpatient food insecurity screened negative for household food insecurity. And finally, participants with inpatient food insecurity had a 2.4 day longer length of stay in the hospital and 1.8 times higher odds of readmission within 30 days.

"These findings indicate the importance of screening specifically for inpatient food insecurity ," DeWitt said. "Identifying caregivers who need additional support will improve health and reduce disparities in hospital outcomes."