The prevalence and perceived health consequences of hunger in emergency department patient populations.

OBJECTIVES: Hunger is associated with chronic poor health and may force patients to make choices that acutely impact their health. This study was conducted to determine the prevalence of hunger, some of the choices it forces, and its perceived health effects among emergency department (ED) patients. METHODS: A validated survey about hunger, choosing between food and medicine, and perceived adverse health outcomes was administered in English, Spanish, and Somali to non-critically ill ED patients or their parents. Demographics, rates of hunger, numbers of yearly ED visits, and decisions between buying commodities or medications were assessed. Relationships between variables were summarized with odds ratios (ORs), 95% confidence intervals, and logistic regression. RESULTS: Of 930 respondents, 23.7% screened positive for hunger and 17.6% bought food instead of medications. Among the hunger-positive respondents, 44% believed this choice caused illness, and of these, 69% sought ED assessment and 35% believed they were hospitalized because of this choice. Predictors of hunger were low income (OR = 3.3), illicit drug use (OR = 5.5), chronic illness (OR = 2.1), Hispanic ethnicity (OR = 1.9), and lack of insurance (OR = 1.8). Buying food instead of medicine was predicted by low income (OR = 2.5), chronic illness (OR = 2.4), and lack of insurance (OR = 3.4). Predictors of illness were chronic illness (OR = 1.8), lack of insurance (OR = 2.8), African American race (OR = 2.0), and "poor" health (OR = 1.9). CONCLUSIONS: These ED patients have high rates of hunger and often choose to buy food instead of medications. Many believe that this choice results in ED visits and hospitalizations. Socioeconomic factors may predict hunger and subsequent ill health.