JAN. 6, 2014
Article link: http://www.nytimes.com/2014/01/07/health/study-finds-more-diabetic-hospital-visits-when-food-budgets-dip.html?_r=1
Poor people with diabetes are significantly more likely to go to the hospital for dangerously low blood sugar at the end of the month when food budgets are tight than at the beginning of the month, a new study has found.
Researchers found no increase in such hospitalizations among higher-income people for the condition known as hypoglycemia, suggesting that poverty and exhausted food budgets may be a reason for the increased health risk.
Hypoglycemia occurs when people with diabetes have not had enough to eat, but continue taking medications for the disease. To control diabetes, patients need to keep their blood sugar within a narrow band. Levels that are too low or too high (known as hyperglycemia) can be dangerous.
Researchers found a clear pattern among low-income people: Hospital admissions for hypoglycemia were 27 percent higher at the end of the month than at the beginning. Researchers said they could not prove that the patients’ economic circumstances were the reason for the admission, but the two things were highly correlated.
The study, published online Monday in the journal Health Affairs, comes as Congress continues to debate legislation that includes the food stamp program for poor Americans. House Republicans are advocating $40 billion in cuts to the program, a step that Democrats oppose.
About 25 million Americans, or 8 percent of the population, have diabetes, according to the Centers for Disease Control and Prevention. The poor are disproportionately affected. The United States spends more than $100 billion a year treating people with the disease, the agency estimates.
Researchers from the University of California, San Francisco, matched hospital discharge records from 2000 to 2008 on more than two million people in California with those patients’ ZIP codes. People living in the poorest ZIP codes, where average annual household income was below $31,000, were counted as low income.
The researchers then examined cases of patients admitted for hypoglycemia. The symptoms include dizziness, sweating or nausea. In rare cases, hypoglycemia can cause death.
For each 100,000 admissions of poor people, about 270 of them were given a primary diagnosis of hypoglycemia, more than the 200 per 100,000 among people of higher incomes. Dr. Hilary Seligman, assistant professor of medicine at U.C.S.F., and the study’s lead author, said the difference was statistically significant.
Dr. Seligman said that she and her colleagues, aware of the debate about food stamps, sought to document whether running out of food stamps or money to buy food at the end of the month damaged people’s health. Previous research had already established that people often give a higher priority to paying monthly bills for rent or utilities, for example, than to buying food, which is managed from day to day.
“People who work minimum wage jobs or live on benefits often have this typical pay cycle pattern,” Dr. Seligman said. “We wanted to examine whether there were adverse health consequences to running out of money at the end of the month.”
Sara Rosenbaum, a professor of health law and policy at George Washington University who was not involved in the study, said the findings were persuasive.
“The patterns here are significant,” she said. “The researchers obviously can’t say if food deprivation was the definitive triggering event, but the findings show a strong association between lack of food and adverse health consequences.”