Household food hardship and asthma morbidity among US children with current asthma

Household food hardship may accompany pediatric asthma morbidity; however, national evidence is limited.

To evaluate the associations between household food hardship and asthma morbidity among children in the United States with current asthma.

We analyzed children aged 5 to 17 years with current asthma in the 2016 to 2024 National Survey of Children's Health (NSCH) and the 2019 to 2024 National Health Interview Survey (NHIS). The NSCH exposure captured difficulty affording preferred food quality or sufficient quantity over 12 months; NHIS compared marginal, low, or very low food security with high food security using a 10-item, 30-day scale. Outcomes were caregiver-reported moderate or severe asthma (NSCH), asthma attack, and asthma-related emergency department or urgent care use (NHIS). Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (aPRs) and predictive margins estimated adjusted prevalence differences (aPDs) with 95% CIs.

The NSCH model included 23,466 children (6699 events), whereas NHIS models included 2774 children (with 1201 attacks) and 2775 children (with 438 acute-care events). Half were aged 5 to 11 years; 54.9% to 57.6% were male; 59.3% to 80.0% had a household adult with more than a high-school education; and 92.6% to 97.5% were insured. Food hardship was associated with moderate or severe asthma (aPR, 1.23; 95% CI, 1.12-1.35; aPD, 6.8 percentage points; 95% CI, 3.8-9.9), attacks (aPR, 1.30; 95% CI, 1.16-1.46; aPD, 12.5 percentage points; 95% CI, 6.7-18.3), and acute-care use (aPR, 1.31; 95% CI, 1.04-1.65; aPD, 4.9 percentage points; 95% CI, 0.6-9.3). At the highest level of hardship, the aPRs were 1.52, 1.55, and 1.92, respectively.

Household food hardship was associated with caregiver-reported asthma morbidity across 2 national surveys.