Interactive Association of Chronic Illness and Food Insecurity with Emergency Room Visits among School-aged Children in the United States

Objective: This study examined the prevalence of food insecurity among children aged 6-17 years and the interactive association of chronic conditions and food insecurity with healthcare utilization, specifically ER visits. Methods: Data on children aged 6-17 (N = 5,518, representing 50,479,419 children) were obtained from the 2017 Medical Expenditure Panel Survey (MEPS). We measured food insecurity (Yes/No) using responses to a 10-item food security scale developed and validated by the USDA, adapted here for the MEPS 30-day window. Healthcare utilization consisted of cumulative ER visits in 12 months. Chi-square tests and adjusted Poisson regression were used to determine interactive associations of chronic conditions and food insecurity on ER visits. All analyses involved complex survey procedures. Results: 20% of school-aged children had food insecurity; 21% had a chronic condition. After adjusting for age, sex, race, insurance coverage, poverty status, physical and mental health status, obesity, and region, we observed that children with chronic conditions and food insecurity had a higher number of ER visits (Incident rate ratio = 2.79, 95% CI = 1.892, 4.120), compared to children without food insecurity and chronic conditions. Conclusions: 1 in 16 school-aged children had both a chronic condition and experienced food insecurity in the last 12 months. Food insecurity in children with chronic conditions was associated with more ER visits. Our findings suggest that policies and programs that provide linkages to community resources can help reduce food insecurity among children in the US and reduce healthcare utilization.