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Prevalence and Impact of Food Insecurity on Orthopedic Patients at the South Texas Hospital of Veterans Affairs
Benjamin L Fitch, B.S.
1, Blaire Peterson VanderWeele, B.S.
1, Srivathsan Ramesh, MD
2, Elizabeth Meyer, B.S.
2, James Saucedo, MD
2; Christina Brady, MD
3(1)UTHSCSA Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, (2)UT Health Science Center, McGovern Medical School, Houston, TX, (3)Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX
Introduction:Food Insecurity (FI) is a common, but often under-reported social determinant of health (SDOH) which is becoming a topic of increasing interest in orthopedic surgery. Along with frailty, anxiety, and depression, these determinants are reversible causes of morbidity which many institutions have the ability to identify and address. This study aimed to characterize the prevalence of key health determinants in the orthopedic setting and highlight screening modalities useful for identifying them.
Methods:682 orthopedic patients in a single clinic were screened using the six-question Household Food Security Survey (HFSS-6), Risk Analysis Index frailty assessment (RAI), hospital anxiety and depression scale (HADS), and 2-question Patient-Health Questionnaire (PHQ-2). Demographics and major findings were represented as raw numbers, percentages and ranges. Categorical variables were analyzed using the Chi-Squared test, and Pearson correlation coefficients were assessed using the Student's t-distribution. A logistic regression model was performed using the maximum likelihood approach, and for coefficients of specific parameters.
Results:The mean patient age in this study was 58.2 years and 20.2% of the screened patients were female. Findings included concern for food insecurity (HFSS-6 > 1) in 29% of patients screened and frailty (RAI > 30) in 21%. Food insecurity had a statistically significant association with frailty (p = 0.0007), anxiety (p <0.0001) and depression (p = 0.0001). The study also demonstrated greater odds of higher numerical frailty score (OR = 1.07, p = 0.001) as well as categorically positive frailty (OR = 2.21, p = 0.012) in food insecure patients.
Conclusions:Food insecurity and frailty in orthopedic patients were significantly associated, and at a occurred at a higher rate than the general population. Electronic screening (eScreens) can be effectively integrated into the workflow of orthopedic clinics to identify dispositions associated with morbidity.
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