Association of Vision Impairment With Food Insecurity in U.S. Children

Abstract

Objective: To determine the association between caregiver-reported vision impairment (VI) in children and household food insecurity (FI) in a nationally representative United States (U.S.) sample. We hypothesized that the presence of a child with VI would be associated with an increased likelihood and severity of household FI.

Design: Cross-sectional study.

Participants: A total of 153,285 children aged 0 to 17 years from the 2021 to 2023 National Survey of Children's Health, representing 209,400,289 U.S. children. The analysis compared households with a child with caregiver-reported VI to households with children without VI.

Methods: We used survey-weighted multivariable logistic and ordinal regression models to examine the association between child VI and household FI. Survey weights were adjusted for the pooled 3-year design. Models were adjusted for child age, sex, race/ethnicity, household income, parental education, household size, and marital status. Interaction analyses tested for effect modification by key sociodemographic variables.

Main outcome measures: Household FI, derived from a food sufficiency item and analyzed as both a binary variable (food insecure vs secure) and a 4-level ordinal outcome (food secure, marginal, low, very low security).

Results: After multivariable adjustment, households with a child with VI had 71% higher odds of being food insecure (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI], 1.37-2.14; P < .001) and 77% higher odds of being in a more severe category of FI (proportional aOR, 1.77; 95% CI, 1.44-2.19; P < .001) compared to households with children without VI.

Conclusions: Childhood VI is significantly associated with an increased likelihood and severity of household FI, independent of key socioeconomic factors. These findings identify families of children with VI as a high-risk population, underscoring the need for routine FI screening in pediatric and ophthalmology clinics and for policies that better integrate social and medical support.