Socio-Demographic Factors Associated with Food Insecurity Among Medicare Beneficiaries with Type 2 Diabetes

Abstract

Background: Nearly 10% of Medicare beneficiaries aged ≥65 experience food insecurity. Among this demographic, a greater risk of health impacts exist since many have diet-related chronic conditions such as diabetes (affecting 33% of older adults). Food-insecure, diabetic older adults face increased risks of poor diabetes management and diabetes-related complications due to difficulty adhering to a diabetes-appropriate diet. We examined risk factors associated with food insecurity among Medicare beneficiaries with type 2 diabetes (T2D). Methods: This population-based cross-sectional study analyzed the 2019 Medicare Current Beneficiary Survey Public Use File (MCBS PUF), with a multi-stage cluster sample design and an overall response rate of 65.7%. The study population included community-dwelling, Medicare beneficiaries with T2D aged ≥65 (n=1,343). The MCBS PUF included a 4-item version of the USDA’s food insecurity questionnaire relating to inability to eat balanced meals, skipping meals, eating less, or food running out because of insufficient money. A binary variable was created to represent food insecurity with ≥2 affirmative responses designated as food insecure based on a previously established algorithm. Descriptive statistics and survey-weighted multivariable logistic models were used to examine the risk factors of food insecurity based on socio-demographic information, health conditions, and insurance coverage. Results: Approximately 11.6% (representing 1.0 million) of study participants with T2D reported food insecurity, with higher proportions for underserved populations such as income <$25,000 (23.9%) and non-Hispanic Black beneficiaries (21.7%). Using multivariable analysis, non-Hispanic Black beneficiaries were more likely to report food insecurity than Non- Hispanic White (odds ratio [OR]=2.44; 95% CI, 1.39-4.29). Beneficiaries with an income <$25,000 were more likely to report food insecurity than for income ≥$25,000 (OR=2.76; 95% CI, 1.34-5.71). Enrollment in Medicare Advantage (vs Traditional Medicare; OR=1.62; 95% CI, 1.07-2.45), having Medicare-Medicaid dual eligibility (vs nondual eligible; OR=2.14; 95% CI, 1.18-3.90), and living with functional limitations (e.g., ADLs ≥1 vs no limitations; OR=2.74; 95% CI, 1.64-4.59) were positively associated with food insecurity. Conclusion: We found socio-demographic disparities in food insecurity exist among Medicare beneficiaries with T2D. Implementation of screening protocols and interventions related to social determinants of health during Medicare wellness visits may help mitigate food insecurity among this demographic.