Association between Food Insecurity and Health-Related Quality of Life: a Nationally Representative Survey

Abstract

BACKGROUND: Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity. OBJECTIVE: To determine the association between food insecurity and several validated HRQoL instruments in US adults. DESIGN: Cross-sectional. PARTICIPANTS: US adults (age ≥ 18), weighted to be nationally representative. MAIN MEASURES: Food insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D). KEY RESULTS: In December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% selfidentified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p < .0001 for all). The magnitude of the difference between food-insecure and foodsecure participants was largest with the SF-6D, EQ-5D, and PROPr; among individual PROMIS domain scores, the largest difference was for ability to participate in social roles.CONCLUSIONS: Food insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.

Measuring population health: association of self-rated health and PROMIS measures with social determinants of health in a cross-sectional survey of the US population

“…As an illustration of the use of different measures, consider the results for food insecurity, which is a good exemplar of SRH changes because it has one of the lowest odds ratios (0.279) and has received a full exploration in a prior publication [ 30 ]. Food insecurity was assessed based on responses to 3 food insecurity items used in the USDA Household Food Security Survey Module [ 31 ].…”

“…A full understanding of these CCs and SDoH would require further adjustments that are informed by theoretical models for each CC and SDoH. For example, models of food insecurity should be adjusted for other correlated factors such as household income [ 30 ]; each row of Table 1 could have a full independent exploration and the data are available for such analyses. As such, comparisons across or within CCs or SDoH should be interpreted as illustrations of the approach and not as well-developed estimates of differences for use in policy decisions.…”

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity

“…Food insecurity (FI), defined by the Food and Agriculture Organization (FAO) as the lack of physical, economic, and social access to safe, sufficient, and nutritious food ( 8 ), affects physical and mental health, both considered dimensions of quality of life (QOL), along with social health, material wellbeing, and development and activity ( 9 , 10 ). FI has been associated with multiple nutrition-related health outcomes, including, but not restricted to, dietary inadequacies, obesity, poor general health, and a myriad of chronic health conditions among adults ( 11 , 12 ).…”

Senior food insecurity in the USA: a systematic literature review

“…Lower educational attainment, lower household income, female gender, having a disability, and being non-white race/ethnicity are associated factors that have https://doi.org/10.1017/S1368980022002415 Published online by Cambridge University Press been consistently documented to have a negative association with food security for decades by the USDA through the annual Current Population Survey Food Security Supplement. (38) Similarly, being a smoker, (39)(40)(41)(42) having poorer self-reported health, (43)(44)(45)(46) chronic disease, (12) poor mental health outcomes, (7,11) and medication non-adherence (45,(47)(48)(49) are documented in the peer reviewed literature to have a negative association with food security. Though limits in physical functioning are less documented in non-older adult populations, one well established likely related factor is disability status.…”