(P17-006-25) The Influence of Household Food Insecurity Changes on Health Care Utilization Among Youth and Young Adults with Diabetes: A Propensity Score Analysis

Objectives: We examined the association between household food insecurity (HFI) changes and hospitalization, emergency department (ED) visits, and urgent care visits in youth and young adults (YYA) with diabetes.

Methods: Longitudinal data (2016-2022) from SEARCH for Diabetes in Youth and SEARCH Food Security Cohort studies were collected at three timepoints including 801 YYA with diabetes. Household food security was ascertained for the prior 12 months with the US Household Food Security Survey Module, and changes between baseline and second timepoint were categorized as persistently food insecure (FI), became FI, became food secure (FS), or persistently FS. Healthcare utilization in the last 12 months was measured at the final timepoint as a binary outcome (yes, no) for each visit type (hospitalization, ED, and urgent care) through a self-reported survey. The association between HFI and healthcare utilization was analyzed using propensity score weighting to balance demographic, socioeconomic, and clinical confounders, odds ratios (OR) with 95% confidence intervals (CI) were calculated for healthcare utilization outcomes.

Results: Before weighting, YYA who were persistently FI had higher odds of hospitalization (OR = 3.25, 95% CI = 1.84-5.73), ED visits (3.27, 95% CI = 2.03-5.26), and urgent care visits (2.10, 95% CI = 1.26-3.50) compared to those who were persistently FS. After weighting, the associations remained robust, with elevated odds of hospitalization (3.25, 95% CI = 2.08-5.07), ED visits (3.27, 95% CI = 2.23-4.78), and urgent care visits (2.10, 95% CI = 1.40-3.16). For those who became FI or became FS, the significant associations observed before weighting for ED visits persisted after weighting (2.03, 95% CI 1.29-3.18, and 2.37, 95% CI 1.56-3.61, respectively), but these associations were not significant for urgent care visits and hospitalizations.

Conclusions: Results demonstrate that HFI, whether past or current, is associated with higher likelihood of ED visits, and persistently having FI is consistently associated with increased healthcare utilization overall. Future studies are needed to improve understanding of pathways leading from food insecurity to increased hospitalization and to differentiate between diabetes-related and other health care utilization.

Funding Sources: NIDDK (R01DK117461, 1R01DK127208), NIGMS (T32-GM081740)