370 - Household Hunger after Hospitalization

Publication Number: 4363.370

Sarah J.. Kopp, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Michael Lugo, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kerry Tepe, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katherine Auger, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Food insecurity (FI) impacts approximately ~25-43% of families with hospitalized children, which is higher than the national household FI rate of 15-20%. Hospital admission imposes a significant financial burden on families which could exacerbate FI in the immediate post-hospitalization period. However, little is known about the rate of FI and hunger in families following pediatric admission.

Objective: To understand rates and predictors of household hunger after pediatric hospital discharge.

Design/Methods: We conducted a prospective cohort study of caregivers of hospitalized children < 21 years old with Medicaid insurance. Participants completed the United States Department of Agriculture 6-item Household Food Security Survey Module (USDA-6) at three time points. Our primary predictor was baseline food insecurity in the past 12 months, which we measured with the USDA-6 administered during hospitalization. Participants were categorized into baseline groups: food secure (USDA-6 score 0-1), food insecure (2-4), and very food insecure (≥5). Our primary outcome of interest was hunger after discharge which was assessed with an adapted version of the USDA-6 at 14 and 90 days after discharge. We adapted the stem of the questions to ask about the post-discharge time period (i.e., "In the last two weeks..."). "Hunger" was defined as USDA-6 scores of ≥2 (food insecure/very food insecure) in the 14 and/or 90 days after discharge. We used multivariable logistic regression to identify predictors of hunger. Income, race, ethnicity, public benefits enrollment (e.g., WIC and SNAP), Childhood Opportunity Index, and caregiver age were hypothesized to be predictors. We adjusted for covariates of household size and month of recruitment.

Results: Of 300 enrolled families, the plurality of caregivers identified as Black (47%) and non-Hispanic (92%), and most had received public nutrition benefits in the last year (79%; Table 1). In the year prior to hospitalization, 41% of households experienced food insecurity. Hunger during the post-hospitalization period was common with 46% reporting hunger in the 14 days after hospitalization and 50% within 90 days of hospitalization (Figure 1). In the final adjusted regression model, only baseline USDA-6 score was a significant predictor of hunger after hospitalization (Table 2).

Conclusion(s): Hospitalization worsens food insecurity. Screening positive for FI during hospitalization is a significant predictor of post-discharge hunger, which emphasizes the importance of in-hospital screening and connecting at-risk families with resources.

Table 1
Caregiver Sociodemographic Characteristics and Association with Baseline Food Security Status

Figure 1
Sankey diagram depicting changes in food security and household hunger status throughout the course of the prospective study. This figure demonstrates the dynamic nature of food security, with many participants changing groups within 90 days of discharge. Overall, there was a downward trending trajectory, with more participants with baseline food security developing hunger than food insecure participants achieving no hunger.

Table 2
Rates and Odds of Household Hunger within 14 and 90 Days After Hospital Discharge