Food Insecurity As a Determinant of Poorer Health-Related Quality of Life Among Patients with Chronic Conditions in the United States

OBJECTIVES: Food insecurity (FI), defined as inadequate access to food needed for healthy and active living due to insufficient resources, affected 12.8% of United States (US) households in 2022. The deleterious effects of FI on health and well-being are well-documented. Yet, this important social determinant of health is underrepresented in patient-reported outcomes research. We evaluated associations between FI and health-related quality of life (HRQoL) among patients with prevalent chronic conditions.

METHODS: Data from the 2023 US National Health and Wellness Survey were used to construct cohorts of patients with heart disease (HD; N=6,557), cancer (N=7,910), chronic lung disease (N=8,084), stroke (N=1,566), depression (N=16,299), type 2 diabetes (T2D; N=6,341), and chronic kidney disease (N=1,705). FI was evaluated with the Hunger Vital Sign^TM 2-item screener. HRQoL was measured with the RAND-36 (Physical Health Composite (PHC); Mental Health Composite (MHC) T scores) and EQ-5D index scores. Linear regression models estimated mean HRQoL scores, relative to FI, adjusting for race/ethnicity, income-to-poverty ratio, sex, marital status, education, smoking status, alcohol use, Charlson Comorbidity Index, and age. The extent to which FI improved the predictive validity of models was evaluated with the change in R² attributed to FI.

RESULTS: FI was related to worse HRQoL across all cohorts (ps<0.001). The largest differences between patients who were food secure vs food insecure were observed in the T2D (PHC: 41.9 vs 35.7, ΔR²=3.9%; MHC: 45.2 vs 36.8, ΔR²=5.9%; EQ-5D: 0.778 vs 0.680, ΔR²=4.2%), cancer (PHC: 45.5 vs 37.8, ΔR²=4.1%; MHC: 48.1 vs 39.2, ΔR²=4.8%; EQ-5D: 0.811 vs 0.698, ΔR²=4.6%), and HD (PHC: 40.9 vs 34.7, ΔR²=3.7%; MHC: 44.3 vs 36.6, ΔR²=4.7%; EQ-5D: 0.763 vs 0.671, ΔR²=3.7%) cohorts.

CONCLUSIONS: Our results show several therapeutic areas where FI is associated with health outcomes, and suggests type 2 diabetes, cancer, and heart disease may be conditions where improvements to food security is of utmost importance.