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

Walker, Rebekah J.; Chawla, Ajay; Garacci, Emma; Williams, Joni S.; Mendez, Carlos E.; Ozieh, Mukoso N.; Egede, Leonard E.

doi:10.1016/j.annepidem.2019.01.014

Cited by 47 publications

(52 citation statements)

References 37 publications

(42 reference statements)

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“…While prior studies have documented an association between moderate and severe food insecurity and mortality at all ages [25,26], our analyses established the association between severe food insecurity and death before age 65 -among low-income adults approaching retirement age. Among low-income adults who died during follow-up, those from severely food-insecure households died on average 10 months earlier than their food-secure counterparts.…”

Section: Discussionsupporting

confidence: 38%

“…Low income is a strong predictor of food insecurity, yet the two factors capture substantially different aspects of economic hardship with limited overlap [34,35]. Past research on food insecurity and mortality has not stratified the samples by income [24][25][26]. Our stratification yielded a significant association between food insecurity and pre-65 mortality among low-income adults.…”

Section: Discussionmentioning

confidence: 84%

“…Food insecurity has been linked to poorer health [13][14][15][16][17][18][19], poorer disease management [20][21][22][23], and higher risk of premature mortality [24][25][26][27][28]. We recently found that marginal, moderate, and severe food insecurity were respectively associated with a 10, 11, and 37% higher risk of dying before 83 among Canadian adults 18 years and older [24].…”

Section: Introductionmentioning

confidence: 99%

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

Men

Tarasuk

2020

BMC Public Health

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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.

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Section: Discussionsupporting

confidence: 38%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Men

Tarasuk

2020

BMC Public Health

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“…The graded association between food insecurity status and premature mortality -in particular, the strong association for severe food insecurity -is consistent with previous studies in the United States and Ontario. 22,23 The significant correlations of all levels of food insecurity with potentially avoidable deaths imply that foodinsecure adults benefit less from public health efforts to prevent and treat diseases and injuries than their food secure counterparts. That severe food insecurity was associated with mortality hazard across circulatoryrespiratory and metabolicdigestive diseases is in line with studies documenting greater incidence of these chronic conditions among food insecure adults.…”

Section: Discussionmentioning

confidence: 99%

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Men

Gundersen

Urquía

et al. 2020

CMAJ

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F ood insecurity-inadequate access to food because of financial constraints-is a public health concern in Can ada. 1,2 In 2007/08, 11.3% of households experienced food insecurity; the figure rose to 12.4% by 2011/12. 1,2 Food insecurity is associated with negative health outcomes and higher health care spending in a graded fashion, with more severe food insecur ity corresponding to worse health and greater health care utiliza tion. 3-5 Food insecurity predicts higher incidence of chronic condi tions and poorer management of them. 6-14 Food insecurity is also associated with mental disorders, 15-18 suicidal thoughts 19,20 and suicide attempts. 21 Despite much evidence linking food insecurity to poor health, less is known about the association between food insecurity and mortality. A graded association between severity of food insecurity and all cause mortality risk was found among workingage adults in Ontario, Canada. 22 A study of the US adult population found very low food insecurity-equivalent to severe food insecurity in Canada-was associated with higher allcause mortality. 23 In addition, 2 small studies found food insecurity to be associated with higher mortality odds among HIVinfected adults. 24,25 However, none of these studies examined causes of death. More comprehensive, populationbased research is needed to advance our understanding of the health bur den associated with food insecurity. Linking vital statistics to multiple cycles of a national health sur vey, we conducted a populationbased retrospective cohort study to assess the association between household food insecurity status and Canadian adults' allcause and causespecific premature mortality. Methods Study sample

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“…Food insecurity, defined as the inability to afford and access nutritious foods to eat, disproportionately affects those living in poverty and leads to poor health, higher healthcare costs, and increased risk of mortality [1][2][3][4][5][6][7]. Individuals living with food insecurity are at increased risk of poor quality diet and inadequate nutrient intake, which contribute to muscle mass loss, mobility problems, and frailty at earlier ages than those living with adequate access to nutritious food [8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey

et al. 2020

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Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. Methods Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. Results Food insecurity rates were highest in late-(37.5%) and early-(36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. Conclusions Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.

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

Cited by 47 publications

References 37 publications

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

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

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey

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