Food insecurity and hospital resource utilization

BACKGROUND: Food insecurity (FI) is an important pediatric social risk factor associated with worse health outcomes. However, there is a paucity of data on FI's effects on hospitalized children and hospital-based reutilization. 

METHODS: This single-center, retrospective cohort study included children admitted between 2020 and 2023 to evaluate the effect of FI on hospital utilization (length of stay [LOS], emergency department [ED] revisits, and readmission). FI was identified using the two-question Hunger Vital Sign(TM) at admission, with patients categorized as food secure, food insecure, or missed/refused screening. Multivariable generalized estimating equations, utilizing binomial and negative binomial distributions, were employed to calculated adjusted odds ratios (aOR) and incidence rate ratios (aIRR), respectively, while accounting for patient-level clustering. Models were adjusted for age, sex, race, ethnicity, language, and insurance type. 

RESULTS: We analyzed 31,553 pediatric hospitalizations in the analysis. Results demonstrated that patients in the missed/refused screening group had a significantly increased LOS, with a 73% increase in expected hospital duration (aIRR: 1.73; 95% confidence interval [CI]: (1.60-1.89) p < .0001) compared with the food-secure group. In contrast, no significant associations were found between documented FI and LOS, ED revisit, and 30-day readmission after adjusting for patient clustering. 

CONCLUSIONS: While the relationship between FI and utilization is multifactorial, these findings suggest that patients who are missed by or refuse screening represent a high-acuity cohort with significantly higher resource utilization. Addressing social risk during hospitalization remains an important opportunity for resource connection, and the high utilization among the unscreened population highlights a critical area for improving screening equity and clinical outreach.