Introduction
Methods
Study design and population
Assessment of food security status
Assessment of health outcomes
Assessment of sociodemographic characteristics
Statistical analysis
Results
Participant characteristics
Characteristics, N (%) | Food security status, No. (Survey weighted %) a | |||
---|---|---|---|---|
Full (n = 35,599) | Marginal (n = 5,113) | Low (n = 5,734) | Very low (n = 3,292) | |
Age group | ||||
20–44 | 13,442 (43.1) | 2,517 (57.8) | 2,945 (60.4) | 1,632 (57.9) |
45–64 | 11,728 (36.3) | 1,674 (30.5) | 1,914 (30.6) | 1,190 (33.3) |
≥ 65 | 10,429 (20.6) | 922 (11.7) | 875 (9.01) | 470 (8.77) |
Sex | ||||
Men | 17,903 (49.2) | 2,379 (45.7) | 2,722 (47.2) | 1,600 (47.3) |
Women | 17,696 (50.8) | 2,734 (54.3) | 3,012 (52.8) | 1,692 (52.6) |
Race/ethnicity | ||||
Non-Hispanic white | 17,862 (74.1) | 1,453 (47.7) | 1,511 (44.5) | 1,155 (51.7) |
Non-Hispanic black | 6,994 (9.26) | 1,347 (18.5) | 1,346 (17.4) | 881 (18.9) |
Hispanic | 7,241 (9.78) | 1,831 (25.8) | 2,460 (31.6) | 1,064 (22.9) |
Others | 3,502 (6.84) | 482 (7.98) | 417 (6.51) | 192 (6.55) |
Education | ||||
<High school | 7,821 (13.6) | 1,839 (27.1) | 2,580 (35.8) | 1,332 (32.2) |
High school or GED | 8,001(22.9) | 1,308 (29.5) | 1,380 (27.3) | 848 (29.3) |
Some college | 10,227 (30.7) | 1,433 (31.4) | 1,386 (28.8) | 920 (31.9) |
College graduate or above | 9,503 (32.8) | 522 (12.0) | 381 (8.10) | 184 (6.59) |
Missing | 47 (0.08) | 11 (0.19) | 7 (0.16) | 8 (0.18) |
Family income (IPR) | ||||
≤ 1.0 | 4,102 (7.84) | 1,588 (26.7) | 2,350 (35.7) | 1,581 (44.1) |
1.0–4.0 | 17,390 (44.0) | 2,870, 59.5 | 2,748 (53.0) | 1,474 (48.9) |
≥ 4.0 | 11,315 (41.8) | 278 (7.44) | 154 (3.85) | 42 (2.63) |
Missing | 2,792 (6.20) | 377 (6.35) | 482 (7.45) | 195 (4.31) |
Marital status | ||||
Married or living with partner | 21,931 (65.3) | 2,808 (55.7) | 3,109 (54.2) | 1,460 (44.9) |
Separated/divorced/widowed | 7,685 (17.4) | 1,227 (22.2) | 1,375 (22.2) | 1,039 (29.3) |
Not married | 5,598 (16.1) | 1,050 (21.5) | 1,213 (23.0) | 780 (25.5) |
Missing | 385 (1.23) | 28 (0.59) | 37 (0.57) | 13 (0.35) |
Smoking status | ||||
Never | 19,806 (55.5) | 2,699 (50.4) | 2,883 (47.6) | 1,409 (39.6) |
Current | 6,196 (18.1) | 1,342 (29.2) | 1,694 (33.4) | 1,304 (43.9) |
Former | 9,566 (26.3) | 1,069 (20.4) | 1,148 (18.9) | 578 (16.4) |
Missing | 31 (0.05) | 3 (0.04) | 9 (0.18) | 1 (0.01) |
Insurance coverage | ||||
Yes | 30,194 (87.0) | 3,484 (68.9) | 3,614 (63.3) | 2,054 (63.4) |
No | 5,405 (13.0) | 1,629 (31.1) | 2,120 (36.7) | 1,238 (36.6) |
SNAP participation | ||||
Yes | 2,601 (4,93) | 1,111 (20.0) | 1,533 (25.7) | 1,079 (31.6) |
No | 32,998 (95.1) | 4,002 (80.0) | 4,201 (74.3) | 2,213 (68.4) |
Trends in the prevalence of CMDs by food security status
Association of food security status with CMD
Characteristics | Obesity | Hypertension | Diabetes | Coronary Heart Disease | ||||
---|---|---|---|---|---|---|---|---|
Adjusted odds ratio (95% CI) | P-value | Adjusted odds ratio (95% CI) | P-value | Adjusted odds ratio (95% CI) | P-value | Adjusted odds ratio (95% CI) | P-value | |
Food security | ||||||||
Full food secure | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
Marginal food secure | 1.19 (1.09–1.30) | < 0.001 | 1.11 (1.01–1.21) | 0.05 | 1.36 (1.21–1.54) | < 0.001 | 1.28 (1.09–1.50) | 0.01 |
Low food secure | 1.27 (1.16–1.38) | < 0.001 | 1.07 (0.97–1.19) | 0.20 | 1.27 (1.12–1.44) | 0.001 | 1.71 (1.41–2.06) | < 0.001 |
Very low food secure | 1.23 (1.09–1.39) | 0.002 | 1.13 (1.0-1.29) | 0.16 | 1.49 (1.28–1.75) | < 0.001 | 1.88 (1.48–2.39) | < 0.001 |
Age category (y) | ||||||||
20–44 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
45–64 | 1.28(1.20–1.37) | < 0.001 | 3.90 (3.62–4.20) | < 0.001 | 4.70 (4.28–517) | < 0.001 | 6.17 (5.08–7.50) | < 0.001 |
≥65 | 0.91 (0.84–0.98) | 0.02 | 9.50 (8.64–10.5) | < 0.001 | 8.03 (7.18–8.98) | < 0.001 | 20.6 (17.1–24.8) | < 0.001 |
Sex | ||||||||
Men | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
Women | 1.10 (1.04–1.17) | < 0.001 | 0.64 (0.61–0.68) | < 0.001 | 0.75 (0.70–0.82) | < 0.001 | 0.52 (0.46–0.58) | < 0.001 |
Race/ethnicity | ||||||||
Non-Hispanic White | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
Non-Hispanic Black | 1.52 (1.42–1.63) | < 0.001 | 1.84 (1.71–1.98) | < 0.001 | 1.86 (1.72-2.0) | < 0.001 | 0.73 (0.65–0.82) | < 0.001 |
Hispanic | 1.12 (1.04–1.21) | < 0.001 | 0.80 (0.74–0.87) | < 0.001 | 1.57 (1.43–1.73) | < 0.001 | 0.58 (0.51–0.66) | < 0.001 |
Others | 0.56 (0.49–0.63) | < 0.001 | 1.11 (1.0-1.24) | 0.05 | 1.74 (1.52-2.0) | < 0.001 | 0.95 (0.75–1.20) | 0.29 |
Education | ||||||||
<High school | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
High school graduate or GED | 1.12 (1.03–1.21) | 0.004 | 0.96 (0.88–1.05) | 0.36 | 0.80 (0.72–0.88) | < 0.001 | 0.83 (0.73–0.95) | 0.009 |
Some college | 1.12 (1.04–1.21) | < 0.001 | 0.87 (0.80–0.94) | 0.001 | 0.81 (0.74–0.88) | < 0.001 | 0.82 (0.73–0.93) | 0.001 |
College graduate or above | 0.69 (0.62–0.76) | < 0.001 | 0.63 (0.58–0.70) | < 0.001 | 0.56 (0.50–0.63) | < 0.001 | 0.62 (0.53–0.72) | < 0.001 |
Family income (IPR) | ||||||||
≤ 1.0 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
1.0–4.0 | 1.13 (1.04–1.23) | 0.003 | 1.08 (1.0-1.17) | 0.06 | 0.90 (0.81–0.99) | 0.04 | 0.84 (0.72–0.97) | < 0.001 |
≥4.0 | 1.04 (0.90–1.11) | 0.49 | 1.01 (0.85–1.13) | 0.92 | 0.72 (0.62–0.82) | < 0.001 | 0.66 (0.54–0.79) | < 0.001 |
Marital status | ||||||||
Married | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
Separated/divorced/widowed | 0.99 (0.92–1.06) | 0.71 | 1.21 (1.13–1.30) | < 0.001 | 1.04 (0.94–1.14) | 0.45 | 1.22 (1.09–1.36) | < 0.001 |
No | 0.82 (0.76–0.88) | < 0.001 | 0.80 (0.74–0.87) | < 0.001 | 0.86 (0.75–0.98) | 0.02 | 0.73 (0.60–0.89) | 0.002 |
Smoking status | ||||||||
Never | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
Current | 0.69 (0.64–0.74) | < 0.001 | 0.85 (0.79–0.91) | < 0.001 | 0.82 (0.74–0.90) | < 0.001 | 1.49 (1.30–1.70) | < 0.001 |
Former | 1.12 (1.05–1.20) | 0.001 | 1.07 (1.0-1.15) | 0.06 | 1.18 (1.09–1.29) | < 0.001 | 1.51 (1.35–1.68) | < 0.001 |
Insurance coverage | ||||||||
Yes | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
No | 0.79 (0.74–0.85) | < 0.001 | 0.79 (0.74–0.85) | < 0.001 | 0.71 (0.64–0.78) | < 0.001 | 0.68 (0.57–0.81) | < 0.001 |
SNAP participation | ||||||||
Yes | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
No | 0.73 (0.65–0.81) | < 0.001 | 0.91 (0.83, 1.0) | 0.06 | 0.82 (0.74–0.92) | 0.001 | 0.74 (0.63–0.88) | 0.001 |