Household food hardship and asthma morbidity among United States children with current asthma.

BACKGROUND: Household food hardship may accompany pediatric asthma morbidity, but national evidence is limited. OBJECTIVE: To evaluate associations between household food hardship and asthma morbidity among United States children with current asthma. METHODS: We analyzed children aged 5-17 years with current asthma in the 2016-2024 National Survey of Children's Health (NSCH) and 2019-2024 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 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% confidence intervals (CIs). RESULTS: The NSCH model included 23,466 children (6,699 events); NHIS models included 2,774 children (1,201 attacks) and 2,775 children (438 acute-care events). Half were aged 5-11 years, 54.9%-57.6% were male, 59.3%-80.0% had a household adult with more than high-school education, and 92.6%-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 hardship level, aPRs were 1.52, 1.55, and 1.92. CONCLUSION: Household food hardship was associated with caregiver-reported asthma morbidity across two national surveys.