# Risk of food insecurity and its association with social determinants of health among hospitalized patients in Lebanon

## TL;DR

This study finds that most hospitalized patients in Lebanon face food insecurity, linked to education level and rural residence, highlighting the need for targeted interventions.

## Contribution

The study provides new evidence on the association between social determinants and food insecurity among hospitalized patients in a conflict-affected country.

## Key findings

- 79.5% of hospitalized patients in Lebanon were at risk of food insecurity.
- Residents of rural areas in the North and Bekaa districts had higher odds of food insecurity.
- Higher education levels were associated with lower odds of food insecurity.

## Abstract

Food insecurity is a growing concern globally, particularly in conflict-affected settings. In these contexts, hospitalized patients face heightened risks of poor health outcomes. The present study aims to assess the risk of food insecurity among hospitalized patients in Lebanon and investigate its association with social determinants of health (SDH) amidst multiple crises.

A cross-sectional observational study was conducted from May to October 2021 on a random sample of adult hospitalized patients in five large hospitals across different districts inLebanon. A structured survey was used to collect socio-demographic characteristics, sources of health coverage, and medical history among study participants. In addition, survey included analysis of four indicators considered as integral part of SDH criteria: (1) area of residence and household size, (2) level of education, (3) employment status and type of employment, (4) healthcare access and coverage. Risk of food insecurity among praticipants was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey. Associations between the SDH and risk of food insecurity were explored using logistic regression analysis using STATA V13.1.

Among the 343 participants, the majority (79.5%) were identified as being at risk of food insecurity with 62.4% classified as experiencing mild food insecurity, 15% as moderate, and 2.1% living with severe food insecurity. Higher odds of food insecurity were observed among residents of of predominantly rural areas mainly in the North of Lebanon (OR = 6.59, CI [1.79; 24.32], p = 0.005) and Bekaa (OR = 2.55, CI [0.92; 7.05], p = 0.071) districts. Additionally, participants with higher levels of education, particularly those with high school degree or higher, had lower odds of food insecurity (p < 0.05). Employment status, household size, and healthcare coverage were not found to be significant predictors of food insecurity among hospitalized patients in the multiple logistic regression analysis in the study sample.

The study highlights the critical role of SDH, including educational level and geographical residence on experience of food insecurity among hospitalized patients. Screening for risk of food insecurity and associated determinants in health care settings are critical to design adequate programs and interventions to mitigate the risk of food and nutrition insecurity among vulnerable groups, particularly in conflict-affected settings.