Association between household food insecurity and mortality in Canada: A population-based retrospective cohort study

Overview

Abstract (English)

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. Food insecurity – inadequate access to food because of financial constraints – is a public health concern in Canada. In 2007/08, 11.3% of households experienced food insecurity; the figure rose to 12.4% by 2011/12. Food insecurity is associated with negative health outcomes and higher health care spending in a graded fashion, with more severe food insecurity corresponding to worse health and greater health care utilization. Food insecurity predicts higher incidence of chronic conditions and poorer management of them. Food insecurity is also associated with mental disorders, suicidal thoughts and suicide attempts. Despite much evidence linking food insecurity to poor health, less is known about the association between food insecurity and mortality. A graded association between severity of food insecurity and all-cause mortality risk was found among working-age adults in Ontario, Canada. A study of the US adult population found very low food insecurity – equivalent to severe food insecurity in Canada – was associated with higher all-cause mortality. In addition, 2 small studies found food insecurity to be associated with higher mortality odds among HIV-infected adults. However, none of these studies examined causes of death. More comprehensive, population-based research is needed to advance our understanding of the health burden associated with food insecurity. Linking vital statistics to multiple cycles of a national health survey, we conducted a population-based retrospective cohort study to assess the association between household food insecurity status and Canadian adults’ all-cause and cause-specific premature mortality.

Abstract (French)

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