Association of Vision Impairment With Food Insecurity in U.S. Children.

Abstract

To determine the association between caregiver-reported vision impairment (VI) in children and household food insecurity (FI) in a nationally representative United States (U.S.) sample. We hypothesized that the presence of a child with VI would be associated with an increased likelihood and severity of household FI. Cross-sectional study. A total of 153,285 children aged 0 to 17 years from the 2021 to 2023 National Survey of Children's Health, representing 209,400,289 U.S. children. The analysis compared households with a child with caregiver-reported VI to households with children without VI. We used survey-weighted multivariable logistic and ordinal regression models to examine the association between child VI and household FI. Survey weights were adjusted for the pooled 3-year design. Models were adjusted for child age, sex, race/ethnicity, household income, parental education, household size, and marital status. Interaction analyses tested for effect modification by key sociodemographic variables. Household FI, derived from a food sufficiency item and analyzed as both a binary variable (food insecure vs secure) and a 4-level ordinal outcome (food secure, marginal, low, very low security). After multivariable adjustment, households with a child with VI had 71% higher odds of being food insecure (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI], 1.37-2.14; P < .001) and 77% higher odds of being in a more severe category of FI (proportional aOR, 1.77; 95% CI, 1.44-2.19; P < .001) compared to households with children without VI. Childhood VI is significantly associated with an increased likelihood and severity of household FI, independent of key socioeconomic factors. These findings identify families of children with VI as a high-risk population, underscoring the need for routine FI screening in pediatric and ophthalmology clinics and for policies that better integrate social and medical support.