Association of Food Insecurity With Disease-Related Complications and Healthcare Utilization for Patients With Sickle Cell Disease.

Abstract

Background: Food insecurity is one of several household material hardships (HMH) recognized for their impact on disease severity and healthcare utilization in patients with chronic disease. Sickle cell disease (SCD) is a chronic disease, disproportionately affecting patients of lower socioeconomic status, that results in high rates of disease-related complications and high healthcare utilization. This study examines the relationship between food insecurity and SCD-related complications and healthcare utilization.

Methods: Patients (ages 2-24 years) and/or their parents were surveyed to assess food insecurity status during routine SCD clinic visits from July 2015 to July 2019. Food insecurity status was assessed using the United States Department of Agriculture (USDA) Food Security Short Form (six-item), with a lookback period of 12 months. Sociodemographic characteristics, disease-related complications, and healthcare utilization were abstracted from electronic health records.

Results: Overall, 22% (n = 25) of participant households were food insecure. Food insecurity was associated with significantly higher annual rates of acute chest syndrome (aOR = 3.12, 95% CI: 1.27-7.67), prevalence of cholecystectomy (aOR = 6.29, 95% CI: 1.66-23.80), and a higher number of hospitalizations (aOR = 2.40, 95% CI: 1.04-5.52).

Conclusions: The rates of food insecurity among sampled households of pediatric and young adult patients with SCD were much higher than national (13.4%) and local county rates (13%). Food insecurity was independently associated with more disease-related complications and higher healthcare utilization even after adjusting for age, sex, and sickle cell type. These results suggest food insecurity may be a modifiable contributor impacting morbidity in patients with SCD and should prompt further study into these relationships.