Risk of Hospitalization Tied to Food Insecurity, Social Determinants

Food insecurity, a serious social determinant of health, can create a cycle of health inequity that puts patients at a greater risk for health-related missed workdays and overnight hospitalization, worsening disparities between food-secure and insecure patients, a Health Affairs study found.

Food insecurity is defined by the US Department of Agriculture as “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.”

In 2020, an estimated 13.8 million or 10.5 percent of households in the United States were food-insecure at some point, the USDA determined.

The Health Affairs study, led by researcher Joshua Weinstein, used data from the National Health Interview Survey (NHIS) to examine the relationship between food insecurity, work absenteeism, and overnight hospitalizations among working-age adults with diabetes.

“It is important to consider the possible occurrence of a vicious cycle, whereby food insecurity contributes to worsened health and the consequences of worsened health contribute to food insecurity when assessing the relationship between these two factors,” mentioned the researchers.

The researchers concluded that food insecurity was associated with a greater likelihood of overnight hospitalization in 12 months, with food-insecure patients having a probability of nearly 26 percent compared to food-secure patients with a probability of 17 percent.

However, there was not a significant link between food insecurity and the number of nights spent in the hospital.

The study findings showed that diabetic adults experiencing food insecurity had twice the rate of health-related missed workdays than their food-secure counterparts. In addition, researchers found that food insecurity was tied to nearly a five-day week of missed workdays for health-related reasons across 12 months.

Importantly, the link between food insecurity and work absenteeism creates a negative cycle; missed work leads to lower earned income, which can beget further food insecurity challenges, the researchers pointed out. There could also be adverse health impacts linked to missed work and food insecurity.

In 2011, the average cost of missed workdays for people with diabetes was $277. Cost concerns associated with medical care oftentimes cause patients facing food insecurity to forgo care needs.

“It may force people to make trade-offs among food, medications, and medical supplies; among adults with diabetes, those who are food-insecure are more likely to report cost-related medication underuse,” the researchers wrote in the study. “For hourly workers, missed workdays often represent lost wages, and thus lower incomes than they would have received had they not missed work.”

Policies such as paid sick leave need to be implemented to prevent wage loss, the researchers suggested. In addition, policy changes are necessary to address the layered relationship in which food insecurity turns into poor health outcomes leading to missed workdays and hospitalizations.

“New and creative approaches to addressing food insecurity may help break this cycle,” the researchers advised. “Because medical and social factors are intertwined, policy approaches to improve health for adults with diabetes should address not only healthcare but also social circumstances, such as food insecurity, that affect health. When weighing the costs and benefits of proposed interventions, policymakers should consider potential benefits related to productivity in addition to implications for healthcare use.”

Recently, healthcare organizations have been exploring options related to improving food insecurity.

United for Health, a cross-sector community health coalition, improved food insecurity across five underserved communities in Los Angeles, a study found.

Mutual purpose, cultural awareness, and high member participation were key strategies that contributed to the overall success of the food insecurity interventions.

“Community-engaged approaches to nutrition-related disparities research can lead to highly effective, sustainable health improvements in diverse communities,” Denise Diaz Payán, PhD, MPP, researcher at the University of California, Irvine, said in a public statement. “And one of the ways we can do that is by convening partners from different sectors to form a coalition that addresses these issues collaboratively and directly with impacted community members.”