Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study
Open accessAbstract
BACKGROUND: Food insecurity affects 1 in 8 households in Canada, with serious health consequences. We investigated the association between household food insecurity and all-cause and cause-specific mortality. METHODS: We assessed the food insecurity status of Canadian adults using the Canadian Community Health Survey 2005-2017 and identified premature deaths among the survey respondents using the Canadian Vital Statistics Database 2005-2017. Applying Cox survival analyses to the linked data sets, we compared adults' all-cause and cause-specific mortality hazard by their household food insecurity status. RESULTS: Of the 510 010 adults sampled (3 390 500 person-years), 25 460 died prematurely by 2017. Death rates of food-secure adults and their counterparts experiencing marginal, moderate and severe food insecurity were 736, 752, 834 and 1124 per 100 000 person-years, respectively. The adjusted hazard ratios (HRs) of all-cause premature mortality for marginal, moderate and severe food insecurity were 1.10 (95% confidence interval [CI] 1.03-1.18), 1.11 (95% CI 1.05-1.18) and 1.37 (95% CI 1.27-1.47), respectively. Among adults who died prematurely, those experiencing severe food insecurity died on average 9 years earlier than their food-secure counterparts (age 59.5 v. 68.9 yr). Severe food insecurity was consistently associated with higher mortality across all causes of death except cancers; the association was particularly pronounced for infectious-parasitic diseases (adjusted HR 2.24, 95% CI 1.42-3.55), unintentional injuries (adjusted HR 2.69, 95% CI 2.04-3.56) and suicides (adjusted HR 2.21, 95% CI 1.50-3.24). INTERPRETATION: Canadian adults from food-insecure households were more likely to die prematurely than their food-secure counterparts. Efforts to reduce premature mortality should consider food insecurity as a relevant social determinant.
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Severe food insecurity is associated with morbidity and premature mortality in Canada.
“The significantly higher prevalence of severe food insecurity among non-students compared to students is important given the well-documented associations between severe food insecurity and morbidity and premature mortality in Canada [31–33].”
From Prevalence and sociodemographic correlates of food insecurity among post-secondary students and non-students of similar age in Canada (2023) · cites this paper as [32]
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Self-citation
- Authors
- Men, F., Gundersen, C., Urquia, M. L., & Tarasuk, V.
- Affiliations
- St. Michael's Hospital (CA)
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2020-01-19
- Volume
- 192
- Issue
- 3
- Pages
- E53-E60
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC6970600
- OpenAlex
- W3000237791
- Cited by
- 121
- References
- 54
- Citations by year
- 2026: 10 · 2025: 18 · 2024: 19 · 2023: 23 · 2022: 23 · 2021: 22 · 2020: 6
- FWCI
- 19.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (153260_1)
- 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
- household food insecurity, premature mortality, all-cause mortality, cause-specific mortality, unintentional injuries, suicide, social determinants of health, Canadian adults
- MeSH terms
- Adult, Aged, Canada, Cause of Death, Cross-Sectional Studies, Family Characteristics, Female, Food, Food Supply, Health Surveys, Humans, Male, Middle Aged, Mortality, Nutritional Status, Retrospective Studies, Socioeconomic Factors, Databases, Factual
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