Association between Food Insecurity and Health-Related Quality of Life: a Nationally Representative Survey

Abstract

Background: Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity’s role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity. Objective: To determine the association between food insecurity and several validated HRQoL instruments in US adults. Design: Cross-sectional. Participants: US adults (age ≥ 18), weighted to be nationally representative. Main Measures: Food insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D). Key Results: In December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% self-identified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p