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.

Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data

“…The results are consistent with past literature on pain and emergency department visits, further confirming food insecurity as a determinant of health and health service use. [14][15][16][17][18][19][20][21][40][41][42][43] The alignment of our findings with the literature highlights the disproportionate burden that food insecurity places on the Canadian health care system. 15,16 Although pain is more prevalent among women than men for biological and social reasons, 23 food insecurity affected both sexes' risk of paindriven emergency department visits similarly.…”

“…11,12 As a well-established social determinant of health, food insecurity has been associated with multiple negative health outcomes, including mental disorders, substance use and suicide. [13][14][15][16][17][18] Population research connecting food insecurity and pain is rare. As a notable exception, food insecurity has been associated with self-reported chronic pain among Canadian adults and adolescents in a graded fashion.…”

Food Insecurity amid the COVID-19 Pandemic: Food Charity, Government Assistance, and Employment

“…Food insecurity has also been associated with poorer housing conditions in previous studies ( Deaton, Scholz, and Lipka 2020 ; Fafard St-Germain and Tarasuk 2020 ; Kirkpatrick and Tarasuk 2011 ) and with riskier living and employment conditions in the present study. Although sensitive to the adjustment of demographic covariates, the differential odds of filling prescriptions and having a plan to care for ill relatives are in accordance with the much higher prevalence of chronic health problems among individuals in food-insecure households ( Dowd et al 2009 ; Gucciardi et al 2009 ; Jessiman-Perreault and McIntyre 2017 ; Kirkpatrick et al 2010 ; McIntyre et al 2017 ; Men, Elgar, and Tarasuk 2021 ; Men et al 2020a , 2020b ; Men and Tarasuk 2020 ; Men et al 2021 ; Polsky and Gilmour 2020 ; Tait et al 2018 ; Tarasuk, Cheng, et al 2018 ). Those measures were likely taken to cope with existing health issues.…”

“…Taking these differences into account, Statistics Canada’s comparison of the results in May with population data on food insecurity before the pandemic suggests that there was a 39 percent increase in the prevalence of the problem ( Statistics Canada 2020c ). This is concerning given that food insecurity is strongly correlated with negative health outcomes in Canada, including poorer mental health ( Jessiman-Perreault and McIntyre 2017 ; McIntyre et al 2017 ; Men, Elgar, and Tarasuk 2021 ; Men et al 2020b ; Polsky and Gilmour 2020 ; Tarasuk et al 2013 ; Tarasuk, Cheng, et al 2018 ; Zajacova et al 2020 ), chronic pain ( Men et al 2021 ), diabetes ( Dowd, Zajacova, and Aiello 2009 ; Gucciardi et al 2009 ; Tait et al 2018 ), increased likelihood of hospitalization for acute and chronic conditions ( Kirkpatrick, McIntyre, and Potestio 2010 ; Men et al 2020b ; Tarasuk, Cheng, et al 2018 ), and premature deaths from infectious diseases and other causes ( Men et al 2020a ; Men and Tarasuk 2020 ). Food insecurity could potentially heighten the risk of COVID-19 infection through immunologic decline driven by nutrient inadequacy.…”

The relationship between diet quality and the severity of household food insecurity in Canada

“…As household food insecurity rises in Canada (2) and the Canadian government launches small-scale market and voucher programmes to improve vulnerable households' access to fresh produce (43) , current nationally representative data on the nutritional implications of food insecurity are needed. The much more negative associations between severe food insecurity and health in Canada (12,15,16,18,19,44) , coupled with evidence of the extreme financial hardships that define this condition (45)(46)(47)(48) , suggest that food intakes may be particularly compromised in severely foodinsecure households. Drawing on 24-h dietary intake recall data from the population survey conducted in 2015, the objective of the current study was to examine the relationship between the dietary intakes of Canadian children and adults and their household food insecurity status, considering multiple indicators of diet quality and applying a four-level categorical variable (49) to differentiate the severity of household food insecurity.…”