Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use

KEY POINTS: Food insecurity and housing instability may affect dialysis outcomes through health behaviors like treatment adherence and their effect on access to transplantation or home dialysis therapies. People on hemodialysis who were younger, with less educational attainment, with lower incomes, or experiencing financial strain were more likely to experience material need insecurities. Participant race was not associated with material need insecurities, although residential segregation moderated associations between age, sex, and food insecurity. BACKGROUND: Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population. METHODS: We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington, DC metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual-level and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models. RESULTS: Of the 305 participants who completed study surveys, 57% were men and 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes, or experiencing financial strain were more likely to have material need insecurities (P < 0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared with women (odds ratio 3.7; 95% confidence interval, 1.61 to 8.53); younger participants (age <55 years) had increased odds of food insecurity compared with older participants (odds ratio 3.3; 95% confidence interval, 1.49 to 7.32). Associations between sex or younger age category and food insecurity were not statistically significant in less segregated counties (P interaction for residential segregation×sex: P = 0.006; residential segregation×younger age category: P = 0.12). CONCLUSIONS: Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes. PODCAST: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3