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

Abstract

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

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

“…Our findings also raise the question of the causal mechanism underpinning the elevated mortality observed among severely food-insecure adults of preretirement age. Seniors and non-seniors have been clustered together in past research linking food insecurity to vital status [24][25][26]. Our exploratory analyses found that severely food-insecure adults from our sample were more likely than their food-secure counterparts to die from infectious-parasitic disease, unintentional injuries and suicides although chronic conditions claimed the great majority of pre-65 deaths irrespective of one's food insecurity status (results not shown due to limited death tolls).…”

“…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.…”

“…Consistent with prior literature [24,25], we controlled for covariates that may confound the association between food insecurity and pre-65 mortality, including individual demographic characteristics, baseline health, and household socioeconomic characteristics. Demographic covariates included respondent's sex (male/female) and age at interview (integer years 52-64).…”

“…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]. Severe food insecurity was associated with all causes of death except cancer, with particularly strong linkage to deaths from infectious-parasitic diseases, unintentional injuries and suicides [24]. While we adjusted for age at interview in the models of our study, we did not interrogate the relationship between food insecurity and mortality across ages.…”

“…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]. Severe food insecurity was associated with all causes of death except cancer, with particularly strong linkage to deaths from infectious-parasitic diseases, unintentional injuries and suicides [24].…”