Food insecurity, lack of social support common in IBD
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One in eight patients with inflammatory bowel disease are food insecure and lack social support, according to research published in Clinical Gastroenterology and Hepatology.
Siddharth Singh, MD, MS, of the division of gastroenterology at the University of California, San Diego, and colleagues wrote that limited or uncertain access to nutritional food, which has a prevalence of about 11% nationwide, and factors like lack of social networks or social cohesion and living in unsafe neighborhoods can contribute to adverse health outcomes.
“It is unclear how these [social determinants of health (SDH)] associate with financial toxicity and health care utilization in patients with IBD,” they wrote. “A thorough understanding of the prevalence and impact of these SDH is important to facilitate optimal management of patients with IBD within their socioeconomic context.”
Using data from the National Health Interview Survey 2015, researchers identified adults with IBD and estimated the prevalence of food insecurity and lack of social support. They also evaluated their links with financial toxicity (financial hardship due to medical bills, personal and health-related financial distress, cost-related medication nonadherence, and health care affordability) and emergency department use.
Out of more than 3 million adults in the United States with IBD, investigators estimated that 42% reported at least one SDH, including 12% who reported both food insecurity and lack of social support.
In their analysis, Singh and colleagues found that patients with food insecurity were more likely to experience financial hardship due to medical bills (OR = 6.92; 95% CI, 1.48-7.39), financial distress (OR = 6.92; 95% CI, 2.28-2.1) and cost-related medication non-adherence (OR = 8.07;95% CI, 3.16-5.67). Patients with inadequate social support were also more likely to experience the same difficulties (OR = 2.98; 95% CI, 1.56–5.67; OR = 3.05; 95% CI, 1.64–5.67; OR = 2.71; 95% CI, 1.1–6.66, respectively).
However, neither food insecurity nor lack of social support were associated with increased risk for emergency department use.
“Patients with IBD have high prevalence of food insecurity and lack of adequate social support, and this negatively associates with high financial toxicity and unplanned healthcare utilization,” Singh and colleagues wrote. “Population health management strategies should incorporate universal screening for SDH and empower healthcare teams to address social needs to improve the overall quality of health care delivery, and effectively manage clinical and financial risks.”
Perspective
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Stephen Lupe, PsyD
The number the investigators found looks accurate if you compare it with the other data from other patient populations. There is not a lot of data on food insecurity in IBD. It’s really unfortunate because it is one of those factors that increases stress and increases opportunity to develop exacerbation of symptoms and psychopathology. In populations of people with other diagnosed conditions such as diabetes, food insecurity is connected with an increased risk for depression, stress, and anxiety. Stress and the development of psychopathology can exacerbate IBD symptoms and increases rates of complications. There is definitely a need for more research in this area. It is important for the IBD population. We need to study the rates of insecurity and how insecurity adds to stress, psychopathology, and disease activity. Then, we need to look at possible ways to intervene.
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