Abstract 13810: Diabetes versus Cardiovascular Mortality in the Context of Food Insecurity Among United States Adults

Abstract

Food insecurity has become an important global concern with close associations with cardiovascular disease. However, how food insecurity affects individuals with long-term diabetes is currently unknown. In this study, we assessed the hypothesis that positive diabetes history modifies the effect of food insecurity on cardiovascular disease (CVD) mortality. We analyzed data on adults (≥ 20 years) from the 1999-2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. The causes of death for adults (N=4037) were defined using the International Classification of Disease coding (ICD-10). Complex Samples Cox regression was used to assess if diabetes status modified the relationship between food insecurity and CVD-mortality. During a 11.1-year follow-up, among adults with diabetes, 184 individuals died (15%). The hazard ratio (HR) for CVD-mortality among adults with food insecurity compared with adults without food insecurity, with adjustment for age and gender only, was 1.66; 95% confidence interval [CI: 1.26, 2.20]. The adjusted HR was elevated, 2.13 (CI 1.30-3.48, p < 0.05), among adults with diabetes and food insecurity but close to 1.0 (1.57 CI 0.97-2.54, p = 0.07) among adults with only food insecurity after the results were controlled for medical risk factors (chronic kidney disease (CKD) and obesity) and demographic risk factors (age, gender, ethnicity, education). In conclusion, individuals who are food-insecure and have diabetes have a higher probability of death from cardiovascular disease in long-term follow-up than those individuals without diabetes. Risk scoring and CVD prevention strategies should include screening and surveillance for food insecurity status. Comprehensive and interdisciplinary approaches to reducing cardiovascular disease-related disparities and health risks should be implemented through equity research.