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Revealing the Prevalence and Consequences of Food Insecurity in Children with Epilepsy

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Abstract

Food insecurity (FI) affects more than one in five American children and is increasingly addressed during pediatric primary care. Its relevance during subspecialty care, including in the treatment of chronic conditions like epilepsy, is largely unknown. This study sought to determine the FI prevalence among children with epilepsy and examine the relationship between FI and healthcare utilization, health-related quality-of-life (HR-QOL), and medication side effect control. This was a retrospective cohort study using electronic health record data from children, aged 2–17 years, seen for epilepsy management at an academic pediatric hospital. The primary predictor was household FI status, determined using a validated screening tool employed in the hospital’s pediatric neurology clinics. The primary outcome was unplanned healthcare utilization in the 6 months following initial FI screen. Secondary outcomes were standardized, validated assessments of HR-QOL and epilepsy medication side effects. Nearly 14% of the 691 children seen in the clinics for epilepsy lived in food insecure households. The impact of FI on healthcare utilization varied by race. For Caucasians, healthcare utilization rates were significantly higher among food insecure individuals than food secure individuals (37 vs. 17%, p = 0.003). Among African Americans, healthcare utilization rates did not vary with food security status (p = 0.6). Children in food insecure households had lower HR-QOL (p < 0.0001) and higher medication side effects (p = 0.0005). FI is common among children with epilepsy and may influence adverse health outcomes. Further exploration into how FI and other social determinants influence management of and determine outcomes for chronic diseases is warranted.

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Abbreviations

AED:

Anti-epileptic drug

AT:

Advanced epilepsy therapy

CCHMC:

Cincinnati Children’s Hospital Medical Center

EHR:

Electronic health record

ED:

Emergency department

FI:

Food insecurity

HRQOL:

Health-related quality-of-life

NOS:

New-onset seizure

PedsQL:

Pediatric Quality of Life inventory

PESQ:

Pediatric Epilepsy Side-Effects Questionnaire

USDA:

U.S. Department of Agriculture

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Acknowledgements

The authors would like to express sincere thanks to Dr. Diego Morita, Dr. Avani Modi and all staff members of the Cincinnati Children’s Hospital Medical Center New Onset Seizure clinic as well as Cincinnati Children’s Neurology social workers Debbie Morenz-Harbinger, Derek Racicki, and Jodi Christopfel for their support in project design and data collection.

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Authors and Affiliations

  1. Division of Child Neurology, Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, CA, USA

    Jennifer A. O’Malley

  2. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Bethany M. Klett

  3. Division of General and Community Pediatrics and Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Melissa D. Klein

  4. Division of Child Neurology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nicole Inman

  5. Division of General and Community Pediatrics and Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, ML 7035, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Andrew F. Beck

Authors
  1. Jennifer A. O’Malley
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  2. Bethany M. Klett
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  3. Melissa D. Klein
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  4. Nicole Inman
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  5. Andrew F. Beck
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Correspondence to Andrew F. Beck.

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Conflict of interest

All five of the authors are responsible for the reported research and participated in the concept and design, analysis and interpretation of data, and drafting of the manuscript, and has approved of the submission in its present form. We have no financial relationships, no conflicts of interest related to this project, and no corporate sponsors to disclose.

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O’Malley, J.A., Klett, B.M., Klein, M.D. et al. Revealing the Prevalence and Consequences of Food Insecurity in Children with Epilepsy. J Community Health 42, 1213–1219 (2017). https://doi.org/10.1007/s10900-017-0372-1

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  • DOI: https://doi.org/10.1007/s10900-017-0372-1

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