The Association of Low-Income and Food Insecurity on Chronic Disease: NHANES 2005-2012

Purpose: Food insecurity is a household level economic and social condition of limited or uncertain access to adequate food leading to hunger. It is estimated that 14% of the U.S population will experience food insecurity at any given point during the year. Between 5-6% of Americans are severely food insecure in which meals are skipped with disruptions in eating patterns. The purpose of this study is to evaluate the association of food insecurity and chronic disease among low-income individuals who are particularly at risk for food insecurity. Methods: Data from four NHANES cohorts from 2005-2012 combining eight years of data collection (n = 40,790). The sample was restricted to adults between the ages of 18-65, with income levels below 200% of the federal poverty level guidelines (FPL). The NHANES survey utilizes the Food Security Survey Module (FSSM) which is a validated questionnaire developed by the USDA to measure food security. The dependent variables consisted of a self-reported measures and clinical/laboratory indicators of three forms of chronic disease: hypertension, hyperlipidemia and diabetes. All analyses were conducted in SAS 9.3 for complex survey analysis. Results: Food insecurity was significantly associated with age, race, education level, income, health insurance, and current health status. Crude adjusted models found a significant positive association between food insecurity and hypertension (OR = 1.62, 95% CI 1.40, 1.86), hyperlipidemia (OR = 1.26, 95% CI 1.06, 1.49), and diabetes (OR = 1.92, (95% CI 1.55, 2.37). Additionally, among the most severely food insecure there was a highly significant association between food insecurity and both self-reported and clinical hypertension, (OR = 1.84, 95% CI 1.52, 2.22 and OR = 1.69, 95% CI 1.39, 2.05 respectively). Among adults already diagnosed with disease, food insecurity was associated with inadequate control of diabetes (OR = 1.57, 95% CI 1.14, 2.15) but not hypertension or hyperlipidemia. Conclusion: Food insecure adults were associated with increased cardiovascular risk factors. Given the importance for a healthy diet for disease prevention and health promotion it will be important for policymakers to increase access to affordable, nutritious foods in low-income neighborhoods. Additionally, increased access and utilization of federal food assistance programs such as SNAP (Supplemental Nutrition Assistance Program) can also address the large number of food insecure Americans.