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Nelson K, Brown ME, Lurie N. Hunger in an Adult Patient Population. JAMA. 1998;279(15):1211–1214. doi:10.1001/jama.279.15.1211
From the Departments of Medicine, Hennepin County Medical Center, Minneapolis, Minn (Dr Nelson) and the University of Minnesota Medical School—Minneapolis (Dr Lurie); and the Institute for Health Services Research, University of Minnesota School of Public Health, Minneapolis (Ms Brown and Dr Lurie).
Context.— Although clinical observations suggest that some patients experience
hunger and food insecurity, there are limited data on the prevalence of hunger
in adult patients.
Objective.— To determine the prevalence of hunger and food insecurity in adult patients
at an urban county hospital.
Design.— Cross-sectional survey conducted in 1997.
Patients.— The primary survey included all patients aged 18 years or older who
were admitted to the medicine, surgery, and neurology services during a 2-week
period, and all patients who attended the hospital's general medicine clinic
during 1 week. A second survey included primary care patients who received
insulin from the hospital pharmacy during a 1-month period.
Main Outcome Measures.— Rates of hunger and food insecurity.
Results.— Of 709 eligible patients, 567 (participation rate, 80%) were interviewed
in either the clinic (n=281) or hospital (n=286). An additional 170 patients
who received insulin were interviewed by telephone (response rate, 75%). Of
the primary sample, 68 (12%) respondents reported not having enough food,
75 (13%) reported not eating for an entire day, and 77 (14%) reported going
hungry but not eating because they could not afford food. A total of 222 (40%)
had received food stamps in the previous year and of those, 113 (50%) had
their food stamps reduced or eliminated. Recipients whose food stamps had
been eliminated or reduced were more likely to report not having enough food
(18% vs 13%,P=.006), not eating for a whole day (20%
vs 16%, P=.01), going hungry but not eating (20%
vs 16%, P=.08), and cutting down on the size of meals
or skipping meals (33% vs 27%,P=.01). In multivariate
analysis, independent predictors of hunger included an annual income of less
than $10000 (odds ratio [OR], 7.55; 95% CI, 3.01-18.92), drug use (OR, 3.56;
95% CI, 1.46-8.66), and a reduction in food stamp benefits (OR, 1.73; 95%
CI, 1.01-2.96). Predictors of food insecurity included an annual income of
less than $10000 (OR, 4.12; 95% confidence interval [CI], 1.98-8.58), drug
use (OR, 2.11; 95% CI, 1.66-5.08), and a reduction in food stamps (OR, 2.02;
95% CI, 1.23-3.32). In addition, 103 (61%) patients in the sample of diabetics
reported hypoglycemic reactions; 32 (31%) of these were attributed to inability
to afford food.
Conclusion.— Hunger and food insecurity are common among patients seeking care at
an urban county hospital.
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