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Research
Open Access

Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data

Fei Men, Marcelo L. Urquia and Valerie Tarasuk
January 11, 2022 10 (1) E8-E18; DOI: https://doi.org/10.9778/cmajo.20210056
Fei Men
Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael’s Hospital, Toronto, Ont.
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Marcelo L. Urquia
Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael’s Hospital, Toronto, Ont.
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Valerie Tarasuk
Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael’s Hospital, Toronto, Ont.
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Abstract

Background: As the leading cause of emergency department visits in Canada, pain disproportionately affects socioeconomically disadvantaged populations. We examine the association between household food insecurity and individuals’ pain-driven emergency department visits.

Methods: We designed a cross-sectional study linking the Canadian Community Health Survey 2005–2017 to the National Ambulatory Care Reporting System 2003–2017. Food insecurity was measured using a validated questionnaire. We excluded individuals with missing food insecurity status, individuals younger than 12 years and jurisdiction-years with partial emergency department records. We assessed emergency department visits driven by pain at different sites (migraine, other headaches, chest–throat pain, abdomen–pelvis pain, dorsalgia, joint pain, limb pain, other pain) and their characteristics (frequency, cause, acuity and time of emergency department visit) in Ontario and Alberta. We adjusted for sociodemographic characteristics, lifestyle and prior non–pain-driven emergency department visits in the models.

Results: The sample contained 212 300 individuals aged 12 years and older. Compared with food-secure individuals, marginally, moderately and severely food-insecure people had 1.42 (95% confidence interval [CI] 1.20–1.68), 1.64 (95% CI 1.37–1.96) and 1.99 (95% CI 1.61–2.46) times higher adjusted incidence rates of pain-driven emergency department visits, respectively. The association was similar across sexes and significant among adults but not adolescents. Food insecurity was further associated with site-specific pain, with severely food-insecure individuals having significantly higher pain incidence than food-secure individuals. Severe food insecurity predicted more frequent, multicause, high-acuity and after-hours emergency department visits.

Interpretation: Household food insecurity status is significantly associated with pain-driven emergency department visits in the Canadian population. Policies targeting food insecurity may reduce pain and emergency department utilization.

  • © 2022 CMA Impact Inc. or its licensors

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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CMAJ Open: 10 (1)
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Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data
Fei Men, Marcelo L. Urquia, Valerie Tarasuk
Jan 2022, 10 (1) E8-E18; DOI: 10.9778/cmajo.20210056

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Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data
Fei Men, Marcelo L. Urquia, Valerie Tarasuk
Jan 2022, 10 (1) E8-E18; DOI: 10.9778/cmajo.20210056
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