Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study

Abstract

Food insecurity is a significant public health problem in the United States leading to substantial social, economic, and health care–related burdens. While studies continue to estimate the prevalence of food insecurity, the long-term outcomes are not extensively explored. The purpose of this study was to assess the impact of food insecurity on mortality. We analyzed data on adults (≥ 20 years) from the 1999–2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. Among the total study participants (n = 25,247), 17.6% reported food insecurity. Food-insecure individuals were more likely to be younger in age, minorities, poorer, with lesser education, obese, smokers, and with diabetes compared to food-secure counterparts. During a 10.2-year follow-up, among the food insecure, 821 individuals died (11%). The hazard ratio (HR) for mortality among the food insecure compared with the food secure, with adjustment for age and gender only, was 1.58; 95% confidence interval [CI: 1.25, 2.01]. The adjusted HRs for all-cause mortality, HR = 1.46, CI [1.23, 1.72], p < .001, and cardiovascular mortality, HR = 1.75, CI [1.19, 2.57], p < .01, were statistically significantly higher among food-insecure individuals, after adjustment for multiple demographic and health risk factors. Individuals who are food-insecure have a significantly higher probability of death from any cause or cardiovascular disease in long-term follow-up. Comprehensive and interdisciplinary approaches to reducing food insecurity–related disparities and health risks should be implemented. Including food insecurity in health risk assessments and addressing food insecurity as a determinant of long-term outcomes may contribute to lower premature death rates.

The COVID-19 Pandemic, Stress, and Eating Practices in the United States

“…These social determinants of health have long influenced the health of Americans. Policymakers and public health practitioners should redouble their efforts in preventing stress-related morbidity and premature mortality by implementing interventions that address the negative and detrimental social determinants of health [8,10,[14][15][16] The results of this study suffer from all traditional limitations of cross-sectional study designs (e.g., social desirability, self-reported data, and the inability to establish cause and effect). Also, our sample might have limitations due to the online survey deployment option, which required an internet connection and a reasonably higher level of literacy to answer computer surveys.…”

“…Given such financial insecurity and emotional challenges, it is not surprising that stress was a contributor to unhealthy dietary patterns in our study population. Solving the problems of unemployment, job insecurity, associated stress, and food insecurity requires robust fiscal policies, social protection, and community-based approaches to reducing deprivation and inequalities [ 14 , 15 , 16 ]. These social determinants of health have long influenced the health of Americans.…”

Very Low Food Security Among Low-Income Households With Children in California Before and Shortly After the Economic Downturn From COVID-19

“…Possible explanations include ongoing and enhanced COVID-19-specific CalFresh benefits. Whether federal and California-specific safetynet benefits will have a lasting effect on levels of VLFS and, in turn, chronic diseases associated with food insecurity (10,11), requires ongoing study.…”

Food Insecurity and its Impact on Body Weight, Type 2 Diabetes, Cardiovascular Disease, and Mental Health

“…In 2021, Banerjee and colleagues [ 51 ] showed that people experiencing FI had a 58% higher risk of mortality compared to those not reporting FI. Mortality risk differed by level of FI, with very low food security (HR=2.00, CI:1.16, 3.44) showing the highest risk followed by marginal food security (HR=1.79, CI: 1.10, 2.93) and low food security (HR=1.21, CI:0.64, 2.29).…”

“…Mortality risk differed by level of FI, with very low food security (HR=2.00, CI:1.16, 3.44) showing the highest risk followed by marginal food security (HR=1.79, CI: 1.10, 2.93) and low food security (HR=1.21, CI:0.64, 2.29). When controlling for pre-existing CVD conditions (e.g., myocardial infarction, congestive heart failure), FI had an independent effect on CVD mortality, thereby demonstrating FI’s importance in determining risk profiles for CVD mortality [ 51 ]. While most studies centered on FI and the risk of CVD, Charkhchi and colleagues [ 52 ] used the 2015 Behavioral Risk Factor Surveillance System (BRFSS) to establish a reverse relationship between CVD and increased odds of FI (OR=1.75, 95% CI: 1.12–2.73).…”