(WITHDRAWN) Gender and Age Group Differences in the Association between Household Food Insecurity and Emergency Health Care Utilization in Children: Findings from the 2018-2019 National Survey of Children's Health

Background

Food insecurity has been of great public health concern in the United States. Research has linked food insecurity to a variety of negative child health outcomes that manifest both in the short term and over the life course. However, the role of household food insecurity in emergency health care utilization among children has been understudied. Thus, this study aimed to examine: 1) whether household food insecurity is associated with emergency health care utilization in children, after adjusting for potential confounders, and 2) whether the association varies by gender and age group.

Methods

This secondary study used data from the 2018-2019 National Survey of Children’s Health, a recent cross-sectional study of a nationally representative sample of U. S. children aged 0-17 years. Respondents to the survey were a parent or guardian who had knowledge about the health and health care of a randomly sampled child within their household. Logistic regression analyses were used to examine the association between household food insecurity and emergency health care utilization, accounting for potential confounders (child: age, gender, race/ethnicity, health care needs and status, insurance; parent/household: age, family structure and size, educational attainment, income, SNAP participation). All analyses used sampling weights to adjust for nonresponse and unequal selection bias.

Results

A total of 28,990 children were included in the final analytic sample of whom 4,971 (17.15%) had emergency health care use during the past year. The prevalence rates of mild and moderate-to-severe food insecurity were 23% and 4%, respectively. The results of the logistic regression models indicate a significant positive association between household food insecurity and emergency health care utilization in children, after controlling for potential confounders. Specifically, the odds of emergency health care utilization were significantly higher among children both from mild food insecure (OR = 1.23, p < .05) and moderate-to-severe food insecure (OR = 1.57, p < .01) households than their food secure counterparts.

In the stratified models, the odds of emergency health care utilization were significantly higher only for girls both from mild food insecure (OR = 1.32, p < .01) and moderate-to-severe food insecure (OR = 1.85, p < .05) households than their food secure peers. Lastly, for children aged below 1 year, only moderate-to-severe food insecurity (OR = 3.34, p < .05) was significantly associated with emergency health care utilization. For children aged 1-5 years, both mild food insecurity (OR = 1.32, p < .01) and moderate-to-severe food insecurity (OR = 1.85, p < .05) were significantly associated with the outcome. No significant associations were found for children aged 6-11 years and 12-17 years.

Conclusions/Implications

The findings of this study suggest that household food insecurity is a significant predictor of emergency health care utilization in US children. This study informs levers to target prevention and intervention strategies as well as policy and practice decisions to reduce household food insecurity and thereby promote the health and well-being of children.