Linking Emergency Department Thiamine Deficiency to Food Insecurity and Social Determinants of Health

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

thiamine, adult, aged, alcoholism, cohort analysis, conference abstract, controlled study, drug therapy, emergency care, emergency ward, female, food insecurity, human, lowest income group, major clinical study, male, mass fragmentography, neighborhood, observational study, secondary analysis, social determinants of health, social status, thiamine deficiency, Wernicke encephalopathy

Abstract

Background and Objectives: Food insecurity is a critical social determinant of health (SDOH), and little research exists that links this SDOH to acute illness in emergency care. Leveraging data collected on thiamine (vitamin B1) deficiency, which is known to cause highly morbid diseases such as Wernicke's encephalopathy, we sought to estimate the association between ED thiamine deficiency and food insecurity in neighboring communities. Methods: This was a secondary analysis of an observational study that enrolled adult ED patients to test thiamine stores. The study took place at an urban academic ED serving a low-income community. Exclusion criteria were alcohol use disorder or thiamine administration before enrollment. Investigators collected whole blood thiamine levels and analyzed them with gas chromatography-mass spectrometry. We used each patient's address during study enrollment to determine their GeoID and link to US census data, allowing for neighborhood estimates of SDOH. These included summative measures of food insecurity, the area deprivation index (ADI), and socioeconomic status (SES). Higher levels of these measures indicate worse SDOH. We performed descriptive statistics on the overall cohort and student's t-test or Wilcoxon rank analysis to compare SDOH factors between thiamine-deficient and non-deficient patients. Results: The study included 343 patients, of whom 163 (47.5%) were female and 276 (80.5%) were Black. The mean age was 57.0 (SD 17.4) years. A total of 63 (18.4%) patients were identified as thiamine deficient. The overall mean ADI was 84, and the average food insecurity was 30%. The average level of food insecurity was 31.4 ± 10.4 in neighborhoods of thiamine-deficient patients vs. 29.5 ± 12.9 in neighborhoods of non-deficient patients (difference (+1.9, 95% CI -1.5 to 5.3, p = 0.263)). Patients with thiamine deficiency lived in neighborhoods with higher levels of ADI (+2.9, 95% CI -3.0 to -8.8) and higher SES (+4.2, 95% CI -3.6 to 23.3), though these differences also did not reach statistical significance. Conclusion: This secondary analysis linked the presence of non-alcohol- related ED thiamine deficiency with neighborhood-level food insecurity and other SDOH. While this analysis was underpowered, further research is needed on this intersection of ED-relevant conditions and risks associated with nutrition and SDOH.

Volume

32

Issue

S1

First Page

173

Last Page

174

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