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. 2019 Apr:32:43-48.
doi: 10.1016/j.annepidem.2019.01.014. Epub 2019 Feb 5.

Assessing the relationship between food insecurity and mortality among U.S. adults

Rebekah J Walker  1 , Ajay Chawla  2 , Emma Garacci  3 , Joni S Williams  1 , Carlos Mendez  4 , Mukoso N Ozieh  5 , Leonard E Egede  6
Affiliations

Assessing the relationship between food insecurity and mortality among U.S. adults

Rebekah J Walker et al. Ann Epidemiol. 2019 Apr.

Abstract

Purpose: Significant evidence supports a relationship between food insecurity and health, but little work has investigated its relationship on all-cause mortality within a high resource country, such as the United States.

Methods: Data from the 2003-2010 National Health and Nutrition Examination Survey was matched to National Death Index information. Cox models were used to study the relationship between mortality and food insecurity, adjusting for relevant covariates in a sequential manner (demographics, comorbidities, lifestyle variables, body mass index). Food insecurity was used as dichotomous and as four categories.

Results: Of 20,918 participants, 11.6% (representing 208,789,244 U.S. residents) were food insecure. When food insecurity was dichotomized, there was 49% higher odds of mortality after adjusting for demographics (HR, 1.49; 95% CI, 1.19-1.87). After adjusting for comorbidities, the HR remained significant, but lost significance with adjustment for lifestyle factors and body mass index (HR, 1.15; 95% CI, 0.94-1.42). However, marginal food security lost significance after adjustment for lifestyle variables.

Conclusions: Food insecurity significantly impacts all-cause mortality in the United States; however, lifestyle may explain this relationship. Interventions should account for level of severity when creating targeted programs.

Keywords: Food insecurity; Lifestyle; Mortality; NHANES; Social determinants of health.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflicts of interest.

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