There is an increasing prevalence of hunger and food insecurity in patients presenting to Emergency Departments (ED), especially in inverse proportion to worsening economic security. Estimates suggest hunger and food insecurity affect 14.6% of households overall, 21% of households with children, more than 25% of African-American/Hispanic households, and 42% of households living below the federal poverty line.  For the purpose of this article, “hunger” is defined as not having enough to eat, not eating for an entire day, or not eating because of lack of money to buy food. “Food insecurity” is a frequent antecedent condition defined as the lack of nutritionally adequate food or the limited ability “to secure acceptable food in socially acceptable ways.”

Clinical Question

What is the rate of hunger among patients seeking care in an urban ED?


Cross sectional study. Screened eligible patients during daily 8-hour data collection shifts between June 1st and August 31st in 2007 and 2008. In 2009, random every other day 8-hour shifts between June 1st and August 31st.

Primary Results

  • 26,211 presented to ED during time period
    • 15,732 eligible patients
    • 8044 (51%) enrolled and 7,852 patients included for analysis

Critical Results

  • Over 3-year period, noted increasing rates of reporting any hunger
    • 2007: 20.3%
    • 2008: 27.8%
    • 2009: 38.3%
  • Rate of patients having to choose food over medicines also increased
    • 2007: 20.0%
    • 2008: 18.5%
    • 2209: 22.6%


  • The researchers asked an important question that is under-studied but has significant effects on health
  • Focused on an at risk population


  • Single safety-net hospital reporting may over-estimate prevalence
  • Self-reporting may over- or under-estimate true “hunger”
  • Many patients approached for the study were not available for follow up and, thus, were not included in analysis
  • Study occurred during summer months (occurred in Minneapolis, MN), which historically represents a lower utilization period of socially disadvantaged patients; may under-estimate prevalence
  • Patient enrollment only available 8 hours/day
  • Exclusion of patients who do not speak English or Spanish may under-estimate prevalence because hunger and/or food insecurity has been seen at higher rates in non-English speaking populations
  • Children excluded from study, which may under-estimate prevalence

Author's Conclusions

“A significant proportion of our ED patients experience food insecurity and hunger.
Hunger and food insecurity have become more prevalent among patients seen in this urban county ED over the past 3 years. Emergency physicians should be aware of the increasing number of patients who must choose between obtaining food and their prescribed medications, and should consider the contribution of hunger and food insecurity to the development of health conditions for which ED treatment is sought.”

Our Conclusions

Social determinants of health adversely affect patient health and increase utilization of health institutions, especially emergency services. The prevalence of hunger and/or food insecurity is under-recognized in ED populations, especially in urban safety-net hospitals. This fact may adversely affect ability to create health among socially disadvantaged populations.

Potential Impact To Current Practice

It’s simply not enough to ask if your patient is taking their medications as prescribed but rather to search out the reasons for why. Social determinants are frequently the cause. Emergency providers should actively seek out this information and contact available resources to provide support.

Bottom Line

Hunger and food insecurity are common issues in urban ED patients and, the problem appears to be worsening.