Association between adult food insecurity and mortality among adults aged 20–79 years with diabetes: A population-based retrospective cohort study
Pengbo Fu and Jin Wen should be considered joint first author.
Abstract
Aims
There is limited research on the relationship between food insecurity and mortality among individuals with diabetes. This study aims to investigate the impact of food insecurity on all-cause and cause-specific mortality in adults with diabetes.
Research Design and Methods
This study included 5749 adults with diabetes from the National Health and Nutrition Examination Survey cycles 2003–2018 and followed up until 31 December 2019. Food insecurity was measured by the Food Security Survey Module. Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% confidence intervals for both all-cause mortality and cause-specific mortality.
Results
The weighted prevalence of full food security, marginal food security, low food security, and very low food security was 70.8%, 11.0%, 10.4%, and 7.8%, respectively. Food insecurity demonstrated a significant correlation with diminished diet quality and reduced consumption of healthy foods. Over the course of 42,272.0 person-years of follow-up, we documented 1091 deaths, of which 370 were attributed to cardiovascular disease and 180 to cancer. After adjusting for multiple variables, food insecurity scores were significantly and linearly associated with increased all-cause mortality. Comparing to full food security, participants experiencing very low food security had a multivariate-adjusted HR of 1.48 (1.12, 1.95) for all-cause mortality (ptrend = 0.010).
Conclusions
Food insecurity was associated with increased all-cause mortality and compromised diet quality, especially in individuals experiencing very low food security. Future strategies may necessitate the monitoring of and interventions for food insecurity among individuals with diabetes.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available in NHAHES at https://www.cdc.gov/nchs/nhanes/index.htm. These data were derived from the following resources available in the public domain: NHANES, https://www.cdc.gov/nchs/nhanes/index.htm; NCHS Data, https://www.cdc.gov/nchs/data-linkage/mortality.htm.
