The Association Between Food Insecurity and Diabetes Status by Race and Ethnicity in the United States: An Analysis of National Survey Data 公开
Fong, Caitlyn (Spring 2021)
Published
Abstract
Objective: To evaluate the association between food insecurity and diabetes status in US adults by race and ethnicity and to estimate the potential impact of food security interventions on prevalent diabetes.
Methods: Cross-sectional data from 4,348 adults in the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. Food insecurity was dichotomized as food insecure (very low, low, or marginal food security) or fully food secure (reference). Diabetes status was defined as overt diabetes, prediabetes, and no diabetes (reference). Multinomial logistic regression analysis was conducted to estimate the association of household food insecurity (exposure) with diabetes status (outcome) in all US adults and by race and ethnicity. Analyses controlled for diet quality, gender, age, citizenship status, education level, ratio of family income to poverty, and household size. An attributable fraction approach was used to estimate the fraction of diabetes cases associated with food insecurity.
Results: The study included 1,543 non-Hispanic White adults, 885 non-Hispanic Black adults, 1317 Hispanic adults, and 603 adults of other races. 28.2% were food insecure, 34.6% had prediabetes, and 14.9% had overt diabetes. Whereas there was no association between food insecurity and prediabetes in all US adults, there was a statistically significant association between experience of food insecurity and prediabetes in Hispanic adults (aOR: 1.6; 95%CI: 1.2, 2.3). Among all US adults, those reporting food insecurity had twice the relative odds of overt diabetes (aOR: 2.0; 95%CI: 1.4, 2.7). There was also a strong association between food insecurity and overt diabetes in non-Hispanic White adults (aOR: 2.5; 95%CI: 1.5, 3.9). Up to 6% of overt diabetes cases may be attributed to food insecurity across all races, with non-Hispanic White adults having the highest proportion of attributable cases at 15%.
Conclusions: US adults who report food insecurity in the past 12 months are more likely to have diabetes. The strongest observed association between food insecurity and diabetes, and largest cases of diabetes attributable to food insecurity, was among non-Hispanic white adults. Results suggest that food security initiatives may play a more impactful diabetes prevention role in non-Hispanic White communities compared to racial and ethnic minority communities.
Table of Contents
Chapter 1: Introduction........................................................................................................... 1
Chapter 2: Background & Literature Review.............................................................................. 3
Chapter 3: Methodology.......................................................................................................... 12
Chapter 4: Results.................................................................................................................. 18
Chapter 5: Discussion............................................................................................................. 24
References............................................................................................................................. 28
Appendices............................................................................................................................ 31
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