Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study

Abstract

Background: The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension.

Methods: We linked respondents of the Canadian Community Health Survey 2005-15 to the death records from the Canadian Vital Statistics Database 2005-17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52-64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately.

Results: Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample.

Conclusions: Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.

Keywords: Canada; Food insecurity; Health; Mortality; Pension; Seniors.

Fig. 1

Crude mortality rate and age at death by food insecurity status. Crude mortality rate per 10,000 person-years (blue bars; N = 354,000 person-years) was obtained by dividing observed number of pre-65 deaths by number of person-years traced for each food insecurity level in the full sample. Mean age at death (orange dots; N = 2075 persons) was computed for each food insecurity level by taking the average age at death among those with observed deaths before 65 by 2017

Fig. 2

Hazard ratio of pre-65 mortality by food insecurity status among adults with below-median income. Hazard ratio of pre-65 mortality by food insecurity status was estimated using Cox proportional hazard model, with “food-secure” as the reference category (N = 354,000 person-years). Three sets of models were fitted on the full sample with below-median income, adjusting for no covariate, part of the covariates (respondent’s sex, age at interview, smoker status, alcohol consumption, number of chronic conditions), and all covariates (respondent’s sex, age at interview, smoker status, alcohol consumption, number of chronic conditions, Low Income Measure (LIM) status, homeownership, education attainment, household type, Indigenous identity). Fully adjusted models were further fitted on subsamples below and above LIM. Age at interview and number of chronic conditions were set as stratifying variables in all adjusted models due to their violation of hazard proportionality assumption indicated by Schoenfeld test