Examining the relationship between food insecurity and causes of injury in Canadian adults and adolescents

Abstract

Background Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population. Methods Linking the Canadian Community Health Survey 2005–2017 to National Ambulatory Care Reporting System 2003–2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income. Results Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07–1.25) and 1.35 (95% CI 1.24–1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29–2.53) including self-harm (aRR 1.87; 95% CI 1.03–3.40) and violence (aRR 1.79; 95% CI 1.19–2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22–1.46) including fall (aRR 1.43; 95% CI 1.24–1.65), medical complication (aRR 1.39; 95% CI 1.06–1.82), being struck by objects (aRR 1.43; 95% CI 1.07–1.91), overexertion (aRR 1.31; 95% CI 1.04–1.66), animal bite or sting (aRR 1.60; 95% CI 1.08–2.36), skin piercing (aRR 1.80; 95% CI 1.21–2.66), and poisoning (aRR 1.65; 95% CI 1.05–2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09–2.21), falls (aRR 1.22; 95% CI 1.08–1.37), being struck (aRR 1.20; 95% CI 1.01–1.43), and overexertion (aRR 1.25; 95% CI 1.04–1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries. Conclusions Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity.

Food Insecurity and the Opioid Crisis

“…As such, food insecurity deserves special attention among the set of basic needs that are required to survive. Although we did not test it in our study, the idea that food insecurity leads to opioid use has been supported by many recent studies (Men et al 2021; Men, Urquia, and Tarasuk 2021). However, it is likely that opioid-related deaths have a negative effect on other forms of material hardship.…”

“…However, more recent work has found that food insecurity is associated with an increased risk of injuries, chronic pain, and use of prescription opioids, suggesting that the causal pathway may also flow in the opposite direction (Men et al 2021; Men, Urquia, and Tarasuk 2021). Thus, it is likely that the causal direction flows in both directions between food insecurity and opioid use.…”

“…On the other hand, opioid-related mortality increased slowly from 2001 to the years just after the 2010 drug reformulation before rising steadily from 2013 to 2017. Given the national time trends that clearly go in opposite directions (the national level of food insecurity is falling just as opioid-related mortality increases sharply), we know little about how the opioid epidemic has affected measures of material hardship, such as food insecurity, except for a handful of studies showing illegal drug use generally and opioid use specifically is correlated with food insecurity (Whittle et al 2019; Rose-Jacobs et al 2019; Men et al 2021; Men, Urquia, and Tarasuk 2021).…”

Moment of reckoning for household food insecurity monitoring in Canada

“…Household food insecurity, inadequate or insecure access to food due to financial constraints, is a serious population health problem in Canada, linked to poorer men tal health, 14 higher rates of infectious 5 and noncommunicable diseases 6,7 and inju ries, 8 increased health care utilization, 912 and premature mortality. 13 Monitored since 2005 with the wellvalidated Household Food Security Survey Module (HFSSM) on the Canadian Community Health Survey (CCHS), 14 this problem was widespread and growing before the pandemic.…”

The prevalence and predictors of household food insecurity among adolescents in Canada

“…Based on the 2018 Canadian Community Health Survey, the most recent nationally representative data available, one in five 12-17 year-olds lived in a household affected by some level of food insecurity, compared to one in ten adults 50-64 years of age and almost one in twenty adults 65 and older (Polsky & Garriguet, 2022). Although the health implications of food insecurity for adolescents have not been studied as extensively as those for adults in this country, adolescents in food-insecure households in Canada have poorer quality dietary intakes (Hutchinson & Tarasuk, 2021), higher odds of mental health problems (Men et al, 2021a;Ovenell et al, 2022), and higher incidence of injuries (Men et al, 2021b) compared to adolescents in food-secure households. In the United States, where there has been considerably more research on the relationship between household food insecurity and the health of children and youth, food insecurity among adolescents has been shown to increase their odds of elevated blood pressure and prediabetes (Lee et al, 2019), dyslipidemia (Tester et al, 2016), iron-deficiency anemia (Eicher-Miller et al, 2009), and lower bone mass (Eicher-Miller et al, 2011).…”