Food insecurity during COVID-19 in children with end-stage kidney disease: a pilot study.

BACKGROUND: Food insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic. METHODS: Food insecurity was assessed among families of children (age 0-18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus "pre-COVID" (January/February 2020) to "during COVID" (April/May 2020). RESULTS: A total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels (1.1 mg/dL vs. 0 mg/dL, p = 0.03) and decreased likelihood of having adequate phosphorus control (50% vs. 11%, p = 0.03). CONCLUSION: Food insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.

The social drivers of health for Native Hawaiian and Pacific Islander youth in the United States.

Objectives: To describe the social drivers of health and health status of Native Hawaiian and Pacific Islander (NHPI) youth in the US. Methods: This is a cross-sectional analysis of the 2014 NHPI National Health Interview Survey (NHIS) which surveyed about 3,000 NHPI households, including 1,428 NHPI youth (884 0-12 yo, 421 13-17 yo, and 123 18-21 yo). We described domains of social drivers of health (SDoH), health conditions, and associations of income and food insecurity with body mass index (BMI) for NHPI youth. Results: NHPI youth come from households with a wide range in income. Approximately 20% of the cohort were food insecure. Among 18-21 yo, 10% report chronic medical conditions (5% with prediabetes). 33% of 13-17 yo and 52% of 18-21 yo were overweight/ obese. For 13-17 yo, lower income was associated with higher BMI. There was no association between food insecurity and BMI for any age group. Conclusions: Overweight/ obesity are highly prevalent among NHPI youth which is concerning for development of diabetes, hypertension, cardiovascular and kidney disease. Health efforts should focus on SDoH, obesity prevention and management for NHPI youth.

Neighborhood Socioeconomic Deprivation is Associated with Worse Outcomes in Pediatric Kidney Transplant Recipients.

BACKGROUND: Social determinants of health shape a child's transplant course. We describe the association between neighborhood socioeconomic deprivation, transplant characteristics, and graft survival in US pediatric kidney transplant recipients. METHODS: US recipients <18 years of age at listing transplanted January 1st, 2010, to May 31st, 2022 (N=9,178) were included from the Scientific Registry of Transplant Recipients. Recipients were stratified into three groups according to Material Community Deprivation Index score, with greater score representing higher neighborhood socioeconomic deprivation. Outcomes were modeled using multivariable logistic regression and Cox proportional hazards models. RESULTS: Twenty-four percent (N=110) of recipients from neighborhoods of high socioeconomic deprivation identified as being of Black race, versus 12% (N=383) of recipients from neighborhoods of low socioeconomic deprivation. Neighborhoods of high socioeconomic deprivation had a much greater proportion of recipients identifying as being of Hispanic ethnicity (67%, N=311), versus neighborhoods of low socioeconomic deprivation (17%, N=562). The hazard of graft loss was 55% higher (aHR 1.55, 95% CI: 1.24, 1.94) for recipients from neighborhoods of high versus recipients from low socioeconomic deprivation neighborhoods when adjusted for base covariates, race and ethnicity, and insurance status, with 59% lower odds (aOR 0.41, 95% CI: 0.30, 0.56) of living donor transplantation and, although not statistically significant, 8% lower odds (aOR 0.92, 95% CI: 0.72, 1.19) of preemptive transplantation. The hazard of graft loss was 41% higher (aHR 1.41, 95% CI: 1.25, 1.60) for recipients from neighborhoods of intermediate versus recipients from low socioeconomic deprivation neighborhoods when adjusted for base covariates, race and ethnicity, and insurance status, with 27% lower odds (aOR 0.73, 95% CI: 0.66, 0.81) of living donor transplantation and 11% lower odds (aOR 0.89, 95% CI: 0.80, 0.99) of preemptive transplantation. CONCLUSIONS: Children from neighborhoods of high socioeconomic deprivation have worse graft survival and lower utilization of preemptive and living donor transplantation. These findings demonstrate inequities in pediatric kidney transplantation that warrant further intervention.

Na Kanaka Maoli ma na 'Aina 'E: Exploring Place of Residency as a Native Hawaiian Health Predictor During the COVID-19 Pandemic.

Little is known about the impacts of living in diaspora from the Hawaiian Islands on Native Hawaiian health. To address this, the authors conducted an exploratory analysis using cross-sectional data from the 2021 Native American COVID-19 Alliance Needs Assessment. A total of 1418 participants identified as Native Hawaiian (alone or in any combination), of which 1222 reported residency in the continental US and 196 in Hawai'i. Residency status in the continental US vs Hawai'i was evaluated as a predictor of survey outcomes using likelihood ratio tests on linear and logistic regression models for linear and binary outcomes, respectively. Results showed that NH residency in the continental US was significantly associated with increased odds of reporting fair or poor self-rated health; increased odds for screening positive for anxiety, depression, and suicidality; and increased odds of health insurance loss (P's < .05). Residency in the continent was also associated with lower odds of reporting a diagnosed chronic health condition (P < .05). Residency in the continental US had no observed effect on the odds that participants engaged cultural activities or cultural coping strategies. These results support the role of place of residency as an important Native Hawaiian health predictor during and beyond the COVID-19 pandemic.

Diet Quality and Kidney Outcomes in Adolescent and Adult American Indians: the Strong Heart Family Study.

BACKGROUND: The burden of kidney disease is exceedingly high among American Indians (AIs). We sought to examine the relationship of diet quality, a modifiable risk factor, and kidney outcomes in AI adolescents and adults, hypothesizing that healthier diets are associated with lower odds of incident albuminuria and eGFR decline. METHODS: This is an analysis from the Strong Heart Family Study, a longitudinal study of cardiovascular disease and its risk factors among AIs from Arizona, North and South Dakota, and Oklahoma (n = 1720, mean age 39 + / - 16 years, 16% adolescents at baseline). Participants completed two exams (baseline: 2001-2003; follow-up: 2007-2009). The primary exposure was diet quality, expressed as the Alternative Healthy Eating Index 2010 (AHEI), on a 110-point scale (assessed using a 119-item Block food frequency questionnaire). The primary outcomes were as follows: 1) incident albuminuria (albumin to creatinine ratio 30 mg/g or greater); and 2) eGFR decline of 30% or greater. Generalized estimating equations were used to examine the association of AHEI (in quartiles) with outcomes. RESULTS: Ten percent of participants (6% of adolescents) had incident albuminuria and 2% of participants (2% of adolescents) had eGFR decline. For those with normal fasting glucose levels, the odds ratio (OR) for incident albuminuria comparing extreme quartiles of diet quality (least healthy [reference] versus healthiest quartiles) was 0.48 (95% CI 0.28, 0.81) after adjustment for demographics and comorbidities. CONCLUSIONS: For American Indians with normal fasting glucose, higher diet quality decreases the odds of developing albuminuria. These findings inform future efforts to prevent CKD in American Indian adolescents and young adults.

Food Insecurity During COVID-19 in Children with End-Stage Kidney Disease: A Pilot Study.

Background Food insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic. Methods Food insecurity was assessed among families of children (age 0-18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus "pre-COVID" (January/February 2020) to "during COVID" (April/May 2020). Results A total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels ( p =0.03) and decreased likelihood of having adequate phosphorus control ( p =0.03). Conclusion Food insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.