Out-of-Pocket Healthcare Expenses are Associated with Food Insecurity among South Dakotan Families Who Have Children with Disabilities

Background In 2023, 17.9 percent (6.5 million) of households with children experienced household food insecurity, i.e., an inability to acquire enough food to meet household members’ needs. Many socioeconomic factors can influence food security status, such as environmental conditions, social factors, and financial costs. Families with children with disabilities (CWD) may be at higher risk for food insecurity due to additional financial stressors related to these children’s care.Purpose The purpose of this study was to determine the prevalence of food insecurity, as well as the medical and financial factors associated with an increased food insecurity prevalence, among South Dakota families who have CWD. We hypothesized that South Dakota families with CWD are at an increased risk of being food insecure due to the additional costs associated with medical care for their children.Methods A cross-sectional study design was implemented and conducted utilizing an online survey that was distributed to parents of CWD in South Dakota. The online survey included items from the Household Food Security Survey Module, the National Survey of Children’s Health (NSCH), and items developed de novo. The data was analyzed with SAS 9.4 using descriptive analysis, chi-square tests, and odds ratios.Results Fifty-seven participants completed the survey; 55 were parents and 2 were grandparents of CWD; 60% experienced food insecurity. Respondents who report making out-of-pocket healthcare expenditures were associated with higher odds of experiencing food insecurity among South Dakota families who have children with disabilities (OR=3.54, p=0.03), as well as those who participate in a food assistance program such as the Supplemental Nutrition Assistance Program (OR=7.52, p< 0.001). Among this population, households that had problems paying for medical bills in the last 12 months were significantly associated with experiencing food insecurity (OR=16.0, p=0.005).Conclusions Families with CWD have an elevated food insecurity prevalence, particularly those who have out-of-pocket medical expenses. These results could inform food security screening practices for registered dietitians and social work professionals who work with these populations, as well as inform policy initiatives for more medical assistance for CWD.