STUDY: Low-Income Families And Food Allergies | ReadySetFood
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STUDY: Low-Income Families Spend up to 2.5x More on Food Allergy-Related Emergency Care

According to Northwestern University research, low-income families spend more on emergency and hospital care related to food allergies. They also struggle to access allergen-free foods, allergist care, and resources to treat an allergic reaction.

 

According to Northwestern University Feinberg School of Medicine research, low-income families with food allergic children spend more on emergency and hospital care than higher-income families. Lower-income families also struggle to access allergen-free foods, specialty care related to children’s allergies, and resources to treat an allergic reaction. Today, we’ll review the key findings from this 2016 study.

Researching The Costs Of Food Allergy Care

The Northwestern Medicine study was conducted in 2016 by Ruchi S. Gupta, M.D. (Northwestern University Feinberg School of Medicine, Lurie Children's Hospital of Chicago), Lucy Bilaver, Ph.D., and others. It involved a survey of 1643 parents and other caregivers of food allergic children, conducted from November 2011 to January 2012. 

Results were analyzed in three groups based on families’ household income: less than $50,000 per year, $50,000-$100,000 per year, and greater than $100,000 per year. 


Major findings from this research include:

  • Lower-income families spent an average of 2.5 times more on hospital and emergency care related to their children’s food allergies
  • These families spent less for food allergy specialist visits, suggesting that they’re less likely to visit an allergist and receive the guidance they need to manage their allergies
  • Lower-income families struggle to access the epinephrine they need to treat a severe allergic reaction
  • It’s also harder for lower-income families to access allergen-free foods

Hospital and Emergency Care Costs Of Food Allergies

Compared to the two higher income groups, lower-income families spent an average of 2.5 times more on hospital and emergency care related to their children’s food allergies. 

Lower-income families spent an average of 2.5 times more on hospital and emergency care related to their children’s food allergies. 

The lowest-income families spent an average of $1,021 on allergy-related hospital treatment and emergency department visits per year. 

Meanwhile, higher-income families only spent an average of $434 (middle income group) and $416 (highest income group) per year for this hospital and emergency care.

As other findings from this research show, the higher emergency costs for low-income families may stem from a struggle to access treatments, care, and food that will lessen the risk of an allergic reaction. 

As Dr. Gupta, one of the study’s authors, told Science Daily, "We are worried these children [from low-income families] are not getting access to specialty care to provide detailed education and confirmation of their allergies. This leads to more potential life-threatening allergic reactions that lead to more emergency room visits."

The Costs of Specialty Allergist Care 

Low-income families with food allergic children spent less for food allergy specialist visits, even though they tend to spend more on general physician visits.

On average, the lowest-income families spent $228 for specialist visits and $123 for general pediatrician visits per year, while the highest-income families paid $311 for specialist visits and $103 for general pediatrician visits. 

This suggests that food allergic children in lower-income families are less likely to visit an allergist, be diagnosed with a food allergy, or receive specialist education and guidance on food allergy management---including when and how to give epinephrine.

Availability of Epinephrine

Epinephrine (an Epi-Pen injection) is the only medication that can stop anaphylaxis, a life-threatening allergic reaction. And previous studies have shown that the earlier someone receives epinephrine for a severe allergic reaction, the less likely they are to be admitted to the hospital.

But children from lower-income families have a harder time accessing the epinephrine they would need in an emergency. Previous studies on epinephrine access show that lower-income families are less likely to be prescribed an Epi-Pen to treat allergic reactions.

Packs of two Epi-Pens can often cost several hundred dollars if a family is paying cash and can’t apply insurance towards the cost. 

Also, as Dr. Gupta and others mentioned in the 2016 report, children covered under Medicaid may not have a copay that they can use for an Epi-Pen.  

In fact, one previous study reports that Medicaid-covered children who were admitted to the hospital for anaphylaxis were less likely to have had an Epi-Pen injection before admission.

And lower-income families may not always be aware of programs that can help reduce epinephrine costs. 

The financial barriers to Epi-Pen access may be one reason that lower-income families pay more for emergency department and hospital visits.

Access To Specialty Foods

Lower-income families’ spending on emergency care also makes it harder to afford specialty foods free of ingredients that their child is allergic to. But the ability to access safe, allergen-free foods would make these children much less likely to have an allergic reaction in the first place, and less likely to need emergency care. 

As Dr. Gupta explained to Science Daily, "This shows disparities exist in care for low-income children with food allergy. The first line management for food allergy is prevention [of reactions], but costs for special foods and epinephrine auto injectors can be a barrier for many families. Some patients may not have access to allergen-free foods and cannot afford to fill their [epinephrine] prescription."

In the video below, Dr. Gupta provides more information about the impact of food allergies on lower-income families, including the lack of access to allergen-free diets, epinephrine, and allergist visits: 


More Food Allergy Management Resources Are Needed

What steps do Dr. Gupta and the study’s other authors say are needed, to improve care for low-income children with food allergies and possibly decrease hospitalization costs? 

  • Pediatricians should make sure lower-income families can access and afford allergist care. 
  • Pediatricians should make sure lower-income families can access and afford epinephrine prescriptions.
  • Pediatricians should educate families on how to recognize an allergic reaction, and when and how to give epinephrine. 
  • Action must be taken so that epinephrine is readily available in as many public places as possible, just like it is in most schools.
  • Families must be able to access allergen-free foods at low cost. One way this could be accomplished is with standard grocery store aisles dedicated to low-cost foods that are free of top 9 allergens. This would improve access to these foods for families that cannot access or afford specialty stores.

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