A23-12 Starving for Attention: A Mixed-Methods Study of Food Insecurity in Chronic Obstructive Pulmonary Disease

Rationale In patients with chronic obstructive pulmonary disease (COPD), food insecurity is associated with increased dyspnea and more exacerbations, likely due to malnutrition and sarcopenia. However, whether and how pulmonologists assess and address food insecurity is unknown. We sought to identify whether patients with both COPD and food insecurity (and/or financial insecurity, which is closely associated with and captures underreported food insecurity) are more likely to have body mass indices (BMIs) associated with poor COPD outcomes, and to characterize pulmonologists’ attention to food insecurity. Methods We conducted a parallel mixed methods analysis, leveraging an ongoing cohort study that enrolled outpatients with COPD from 2022 to 2024. Participants completed surveys over a 15-month study period, and a subset also had their pulmonary encounters audio-recorded, transcribed, and content analyzed. We identified participants’ self-reported food and financial security at enrollment using a standardized instrument. We calculated the proportions of participants who (1) reported food and/or financial insecurity and (2) had BMIs <21 or > 35 in the study period. We compared the proportions of those with low or high BMI in the food/financially insecure and secure groups with a proportion Z-test. For food/financially insecure participants, we reviewed all clinical documentation for mentions of food insecurity during the study period. We next performed detailed content analysis of pulmonologists’ notes and (when available) encounter transcriptions, identifying and coding discussions of weight, nutrition, or food access. Finally, we triangulated each patient’s survey responses, clinical data, clinical documentation, and (when available) transcript data. Results Out of 145 patients with COPD enrolled from one cohort-participating institution, 50 (34.5%) self-reported food and/or financial insecurity, with six declining to answer. Food/financial insecurity was significantly associated with BMI <21 (26.0% vs. 14.6%, P = 0.049) and insignificantly associated with BMI >35 (20.0% vs. 16.9%, P = 0.32). Thirteen (26.0%) patients experiencing food/financial insecurity had explicit clinical documentation of food insecurity, typically in social work and primary care notes or standardized social needs screens. No patients had documentation of this topic in pulmonologists’ notes, despite occasional mention of related concerns like cachexia. Among eight patients experiencing food/financial insecurity with recorded pulmonary encounters, no pulmonary visits included any mention of food insecurity/access. Conclusions Food/financial insecurity is highly prevalent and associated with BMI <21 in patients with COPD, suggesting that lack of food access may be an up-stream contributor to poor COPD outcomes. Despite this, pulmonologists fail to integrate food insecurity into COPD care.