P4.039: FADD: Relationship of Food Insecurity and Home Address of Children

Background: The presence of healthy food, both quality and quantity, is an important environmental consideration affecting children’s health. 44 million people, including 1 in 5 children, and 100% of counties in the United States, struggle with food insecurity (FI). FI has profound impacts on children’s health and may co-exist with other adverse childhood environmental exposures and social determinants of health (SDoH). FI may persist despite having a reliable income and access to housing. The objectives of this study were to examine if patient reported food insecurity matches existing census tract derived SDoH metrics commonly used for identifying resource poor communities.

Methods: This is a single center, retrospective analysis of data obtained from families of children 0-18 years old that self-identified as FI by Hunger Vital Signs™ during check-in screening at a pediatric multi-specialty practice over a one-year period, January 1- December 31, 2023. After IRB approval, the census tract, Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and Social Vulnerability Index (SVI) correlating with the address of self-reported FI+ pediatric patients were collected. The raw values were places into quintiles with lower quintiles representing higher overall opportunity and lower overall disadvantage and vulnerability. Additionally, we examined the relationship between FI and insurance status.

Results: Data was available for 650 of 652 patients who screened positive for FI in 2023. The cohort’s median age was 8 years old. Cohort demographics are shown in Figure 1. COI and SVI was relatively evenly distributed among quintiles in our cohort of pediatric FI+ patients. For SVI, more patients were found in the higher, more disadvantaged, quintiles. Median ADI was the 3rd quintile, median COI was the 3rd quintile, and median SVI was the 4th quintile. This suggests that, on average, this FI+ pediatric population had moderate disadvantage, moderate opportunity, and high vulnerability. A comparison of the proportion of patients in each quintile is demonstrated in Figure 2. There was no correlation with insurance type and self-reported FI.

Conclusion: Census tract-derived SDoH indices do not demonstrate complete agreement across opportunity, advantage or vulnerability in a population of self-reported pediatric FI. Disadvantage, measured through ADI, does not align well with pediatric FI in the most highly disadvantaged cases. Insurance type also may not be predictive of FI as over one third of those who screened as FI have private insurance. This data overall suggests that food insecurity was present regardless of level of disadvantage, opportunity, or vulnerability in each examined metric of socioeconomic status. Given the significant health concerns and potential for additional adverse exposures an environment of FI creates, more research needs to be done to determine precisely how well these SDoH indices predict FI and if any one index is superior to others.