Food insecurity status and mortality among adults in Ontario, Canada

Abstract

BackgroundFood insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries.MethodsWe use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health.ResultsUsing a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93).InterpretationThese findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality.

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

“…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.…”

“…37 Based on the number of affirma tive answers, households were classified as foodsecure, mar ginally foodinsecure, moderately foodinsecure or severely foodinsecure, following the classification scheme developed by Health Canada and applied in other studies (Appendix 5, available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.190385//DC1). 4,5,22,38…”

The Early Food Insecurity Impacts of COVID-19

“…3 Food insecurity is associated with numerous adverse health outcomes, including chronic conditions such as diabetes mellitus, hypertension, coronary heart disease, depression, and mental health challenges and increased risk of mortality. [4][5][6][7] Evidence from the United States and Canada has found, on average, health care use 8,9 and costs 4,5,8,9 to be substantially higher among adults living with food insecurity compared to others.…”

Food insecurity in Nunavut following the introduction of Nutrition North Canada

“…Our study raises serious concerns about the federal government's continued focus on foodsubsidy initiatives to improve food access in the North. Given the important health implications of food insecurity, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] more effective initiatives are urgently needed to address north ern food insecurity.…”

“…6,[42][43][44] The scale measures food access problems that range in severity from worrying about running out of food to compromising on the quality of food purchased, to eating less or going a whole day without eating because there was not enough money to buy food. 1,5 Because a single affirmative response to the module rep resents an experience of marginal food insecurity associated with adverse health outcomes, 20,21,23,24 households with 1 or more affirmative responses were considered food insecure, and households with no affirmative response were considered food secure. Households that answered none of the items were coded as missing and excluded from the analysis (n = 62).…”