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Cited by 76Food Security and Health in Diverse PopulationsHealth disparities and outcomesFood Security and Socioeconomic Dynamics

Assessing the relationship between food insecurity and mortality among U.S. adults

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Walker, Rebekah J., Chawla, Ajay, Garacci, Emma, Williams, Joni S., Mendez, Carlos, Ozieh, Mukoso N., Egede, Leonard E.·2019·Annals of Epidemiology
DOI 10.1016/j.annepidem.2019.01.014PMC PMC6441375
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Abstract

Purpose Significant evidence supports a relationship between food insecurity and health, but little work has investigated its relationship on all-cause mortality within a high resource country, such as the United States.Methods Data from the 2003-2010 National Health and Nutrition Examination Survey was matched to National Death Index information. Cox models were used to study the relationship between mortality and food insecurity, adjusting for relevant covariates in a sequential manner (demographics, comorbidities, lifestyle variables, body mass index). Food insecurity was used as dichotomous and as four categories.Results Of 20,918 participants, 11.6% (representing 208,789,244 U.S. residents) were food insecure. When food insecurity was dichotomized, there was 49% higher odds of mortality after adjusting for demographics (HR, 1.49; 95% CI, 1.19-1.87). After adjusting for comorbidities, the HR remained significant, but lost significance with adjustment for lifestyle factors and body mass index (HR, 1.15; 95% CI, 0.94-1.42). However, marginal food security lost significance after adjustment for lifestyle variables.Conclusions Food insecurity significantly impacts all-cause mortality in the United States; however, lifestyle may explain this relationship. Interventions should account for level of severity when creating targeted programs.

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  • Food insecurity increases the risk of all-cause and cardiovascular disease mortality in adults.

    “Food insecurity has been shown to increase the risk of all-cause and cardiovascular disease mortality in adults [25,34]”

    From Food Insecurity, Walkability, and Social Determinants of Health: A Cross-Sectional, County-Level Study of Associations with Maternal and Infant Mortality in the United States (2025) · cites this paper as [25]

    The Results report an association between food insecurity and higher all-cause mortality among U.S. adults, although it was no longer significant after adjustment for BMI. The Methods (Mortality Outcome; page unavailable) specify that the study examined all-cause death, not cardiovascular disease mortality. The Discussion also cautions that the data limit causal conclusions, so “increases the risk” is stronger than the study establishes. (LLM, conf=0.89)

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Research works printed but not linked: 1

  1. [2]Marmot M and Wilkinson R, eds. Social Determinants of Health. Second Edition. 2003 Oxford: Oxford University Press.

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Authors
Walker, R. J., Chawla, A., Garacci, E., Williams, J. S., Mendez, C., Ozieh, M. N., & Egede, L. E.
Affiliations
  • Froedtert Hospital (US)
  • University of Wisconsin–Milwaukee (US)
  • Medical College of Wisconsin (US)
Corresponding author
Egede, Leonard E.
ORCID
Venue
Annals of Epidemiology
Publisher
Elsevier BV
Published
2019-04
Volume
32
Pages
43-48
ISSN
1047-2797 (ISSN-L)
DOI
10.1016/j.annepidem.2019.01.014
PMC
PMC6441375
OpenAlex
W2914982200
Cited by
76
References
38
Citations by year
2026: 8 · 2025: 16 · 2024: 8 · 2023: 12 · 2022: 10 · 2021: 11 · 2020: 10 · 2019: 1
FWCI
10.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699)
Topics
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Social Sciences › Health › Health disparities and outcomes
  • Life Sciences › Agricultural and Biological Sciences › General Agricultural and Biological Sciences › Food Security and Socioeconomic Dynamics
Keywords
food insecurity, all-cause mortality, mortality risk, lifestyle factors, body mass index, comorbidities, health disparities, United States adults
MeSH terms
Adult, Aged, Cross-Sectional Studies, Female, Food Supply, Humans, Male, Middle Aged, Mortality, Nutrition Surveys, Poverty, Socioeconomic Factors, Proportional Hazards Models, Young Adult, Social Determinants of Health

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