SNAP Participation Associated With PICU Utilization: A Potential Indicator of Food Insecurity Risk

Introduction: Food insecurity (FI), limited or uncertain access to adequate food, negatively affects child health and health outcomes. Children admitted to the pediatric intensive care unit (PICU) suffer from higher rates of FI than the general population. While federally sponsored food programs, like the Supplemental Nutrition Assistance Program (SNAP), are vital in mitigating FI, participation in such programs may also indicate ongoing FI risk. We hypothesized that increased PICU utilization would be associated with increased FI and SNAP participation at the census tract (CT) level.


Methods: This was a retrospective cohort analysis of PICU admissions at a single center from January 1, 2016, to December 31, 2022, including only Ohio residents under 18 years old. We extracted demographics from the electronic health record. We geocoded addresses to CTs and appended to the Childhood Opportunity Index (COI), a validated multidimensional tool describing neighborhood-level educational, health and environmental, and socioeconomic domains. The primary outcome was CT-level PICU utilization (admission rates per 1000 children). The primary exposure was CT-level SNAP participation; COI was a covariate. We defined the fraction of food assistance (FFA) as the proportion of households receiving SNAP out of the total number of households per CT. We used Poisson regression to test associations between PICU admission rates and FFA.


Results: We identified 10,555 PICU admissions. Children from the lowest opportunity neighborhoods (very low COI CTs) had the highest PICU admission rates [3.74; IQR (2.39, 6.14) p< 0.001] and FFA [0.28; IQR (0.19, 0.38) p< 0.001]. There was a strong association between PICU admission rates and FFA; every 10% increase in FFA was associated with a 14% increase in PICU admission rates. Over the study period, PICU admission rates in very low COI CTs remained high, but FFA declined from 0.31 (IQR 0.23, 0.41 p<.001) to 0.23 (IQR 0.17, 0.33 p<.001).


Conclusions: The lowest opportunity neighborhoods with highest PICU admission rates and FFA received less SNAP support over time, which may indicate a rising risk of FI. These results underscore the importance of screening for social determinants of health, including food security, in the pediatric critical care setting.