213 - Evaluation of Associations among Food Insecurity Severity, Public Benefit Use, and Pediatric Asthma Outcomes

Publication Number: 1202.213

Megan L.. Smith, Children's National Health System, Washington, DC, United States; Shilpa J.. Patel, Children's National Hospital, Bethesda, MD, United States; James Bost, Children's National Hospital, Silver Spring, MD, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States; Jordan Tyris, Children’s National Hospital, Washington, DC, DC, United States

Background: Social needs like food insecurity (FI) are linked to higher asthma prevalence and poorer asthma control, contributing to disparities in asthma prevalence, morbidity, and healthcare use. However, associations between FI severity and food benefit program use with pediatric asthma outcomes remain understudied.

Objective: To describe associations between household FI severity and (1) asthma diagnosis and (2) asthma morbidity. (3) To assess if public food benefit programs modify the relationship between FI and asthma outcomes.

Design/Methods: We conducted a cross-sectional nationally weighted analysis of children aged 2-17 from the National Health Information Survey (NHIS) from 2019-2023. FI (exposure) was measured using the United States Department of Agriculture’s USDA-10 Food Security Questionnaire, categorized as Food Secure (FS), Marginal Food Security (MFS), Low Food Security (LFS), and Very Low Food Security (VLFS). Primary outcomes were parent-reported asthma diagnosis, exacerbation, and urgent care (UC)/emergency department (ED) use in the last 12 months. Food benefit use (modifier, i.e., WIC, SNAP) and demographics were parent-reported. Weighted logistic regression estimated odds ratios and 95% confidence intervals for associations between FI severity and asthma outcomes, adjusting for sex, age, race/ethnicity, insurance, household income, parental education, and household structure. Weighted logistic regressions were then stratified by WIC/SNAP use to examine differences in outcomes by food benefit use.

Results: There were 33,747 children included: median age of 9.6 years, male (51.1%), non-Hispanic White (51.4%), privately insured (55.4%), and household income ratio >1.99 of the FPL (61.5%). The prevalence of asthma was 11.1% (n=3,932) (Table 1). Compared to FS households, there was a stepwise increase in adjusted odds of asthma diagnosis with worsening FI severity (Table 2). Among the 3,932 children with asthma, those with LFS (aOR 1.80 [1.31,2.47]) and VLFS (aOR 2.92 [2.02,4.20]) were more likely to report exacerbation in the past year (Table 2). VLFS was associated with increased UC/ED use (aOR 3.43 [2.21,5.34]) (Table 2). Asthma morbidity was not modified by public benefit use among families with FI (Table 3).

Conclusion(s): FI severity is a significant risk factor for pediatric asthma diagnosis, exacerbation, and healthcare use. The impact of food benefit programs remains unclear and may reflect families with higher FI needs. Screening for FI severity and benefit use may identify a critical population for health system intervention.

Bivariate Analysis of FI Severity, Asthma Prevalence, Asthma Outcomes, and Public Benefit Use
Table 1_PAS Abstract_10.22.pdf

Unadjusted and Adjusted Odds Ratios of FI Severity and Asthma Prevalence and Outcomes
Table 2_PAS Abstract_10.22.pdf

Adjusted Odds Ratios of FI Severity and Asthma Outcomes Stratified by Food Benefit Use [Weighted N=35,536,713 (3,638 Observations)]
Table 3_PAS Abstract_10.22.pdf