Abstract Introduction Energy insecurity (EI), defined as the inability to adequately meet household energy needs, affects 34 million United States households, and is exacerbated by rising utility rates and climate change. Utility shutoffs due to non-payment compromises energy access and can pose challenges in warming and cooling homes. Asthma is exacerbated by indoor environmental conditions, including extreme temperatures. Yet, little is known about the impact of energy insecurity on childhood asthma. Our aim was to examine the prevalence and impact of energy insecurity among children with asthma. We hypothesize that energy insecurity is prevalent among children with asthma and is associated with increased asthma morbidity. Methods We conducted a retrospective quantitative analysis leveraging data from our hospital system’s social needs screening program that specifically asks screening questions about energy insecurity at annual well child visits. We conducted a retrospective analysis of electronic health records data to identify the prevalence of energy insecurity among children ages 5-17 years with an asthma diagnosis. We also examined whether children with energy insecurity were at greater risk of exacerbations (systemic steroid use), emergency department (ED) visits, and hospitalizations. Data were collected annually from 2020-2024 with missing data noted in 2022 and 2023 when our hospital system underwent a transition in survey administration. Data were analyzed using a modified Poisson regression in generalized estimating equations to estimate relative risks (RR), after adjusting for potential covariates (i.e., age, sex, race, ethnicity, asthma-controller usage, and atopy). Results In the most recent year of data collection (2024), which had the largest sample size (n = 1,321), 115 (7.9%) families were energy insecure, while 1,216 (92.1%) families were energy secure. In the univariate analysis, EI was associated with increased systemic steroid use in both 2021 and 2024 as well as hospitalization in 2024 (p 0.01 for all). Similarly, the adjusted Poisson regression model indicated that, in 2024, energy insecure participants had a higher risk of both systemic steroids usage and hospitalization, but not ED visits (RR 95% confidence interval: 1.9 1.4-2.6 and 2.7 1.4-5.1, respectively; p 0.01 for both) (Table 1). Discussion We observed a significantly increased rate in systemic steroid use and hospitalization in patients with EI compared to those not at risk of disconnections. These findings represent a notable disparity in respiratory health between those unable to have their home energy needs met. Addressing EI will likely contribute to improving health disparities in childhood asthma. This abstract is funded by: None
Milki et al. (2026) studied this question.