Prevalence of Food Insecurity and Its Associated Factors Among Ambulatory Hand Patients in a Large Metropolitan Area

Food insecurity (FI) is recognized as an important social determinant of health (SDH) that may disproportionately affect orthopedic patients. However, there are limited publications evaluating FI within the orthopedic hand population. The objective of this study is to evaluate the incidence of FI among hand clinic patients to identify key SDHs that may inform targeted interventions and improve clinical care for patients with hand pathologies.

This prospective cross-sectional study was conducted using patient surveys at outpatient orthopedic hand clinics at an academic institution. Adults ≥18 years with hand or distal upper-extremity pathology were included; excluded were pediatric patients and patients with injuries proximal to the elbow, concomitant nonupper extremity injuries, malignancy, or chronic neuropathy/pain. Surveys included Household Food Security Survey-6 for FI, the Hospital Anxiety and Depression Scale for anxiety and depression, Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for upper-extremity function, and the Risk Analysis Index for frailty. Data collected included demographics, employment, housing status, insurance, zip code, injury characteristics, and secondary outcomes such as infection, reoperation, amputation, and nonunion. Statistical analysis was performed with P < .05 as significant.

Of the screened patients, 21% were FI. Those with low or very low food security had higher average scores on the Hospital Anxiety and Depression Scale, QuickDASH score, and Risk Analysis Index compared to those with marginal or high food security. These findings indicate that lower food security status is associated with worse mental health, frailty, and a higher level of disability.

This study shows an association between patients experiencing FI and factors known to affect outcomes such as frailty, depression, and anxiety. This is revealed further by a statistically significant difference in QuickDASH scores between food-insecure and food-secure patients. FI is an untapped SDH thar may prove modifiable for an at-risk population.

Symptom Prevalence Study IV.