(799) Changes in Food Insecurity and Healthcare Burden Following a PICU Admission

Introduction: Children in food insecure households have higher health care use and poorer health outcomes. Families of children admitted to the pediatric intensive care unit (PICU) report higher food insecurity than the U.S. national average. However, the effect of a PICU admission on a household’s food insecurity is unknown.

Methods: This is a prospective single center observational cohort study conducted between December 2021 and July 2022. English or Spanish speaking caretakers of children admitted to a large academic PICU for >24 hours were eligible. Caretakers of children in state custody, unlikely to survive, or NICU transfers were excluded. Caretakers were approached with an electronic 67 item survey collecting demographics and information about resource insecurities, unmet healthcare needs (UHCN), and special healthcare needs (SHCN) of the child using validated or previously developed questions. Food insecurity was measured using the 18-item USDA food security module. Follow up surveys measured resource insecurities, UHCN, and SCN and were distributed via text or email 4 months after the child’s PICU admission. Families were given 2 months to answer the survey.

Results: Of the 249 household caretaker participants in the initial cohort, 109 (43%) caretakers responded to the follow up surveys. Compared to non-responders, follow-up household respondents tended to be women (p=0.009), wealthier (p=0.032), and more educated (p=0.001). The children of the respondents did not differ by diagnostic category (p=0.7), severity of illness at presentation (p=0.7), or length of stay in the ICU (p=0.8). Of the 109 follow up respondents, 22% (24/109) of households were food insecure at follow up; 58% (14/24) of those food insecure households, were newly food insecure. Additionally, at time of follow up, 76% (83/109) of children had special health care needs and 40% (42/109) had new or more SHCN compared to baseline. 24% (26/109) of children had unmet health care needs and 17% (19/109) reported more unmet health care needs compared to baseline.

Conclusions: Following a PICU admission, caregivers reported new or worsening food insecurity and increased medical complexity of and unmet health care needs for their children. This highlights the complex care burden for families in the months after a PICU admission.