Abstract
BACKGROUND: Food insecurity is an ongoing public health issue that involves limited or uncertain access to food. National rates of food insecurity among U.S. households have increased from 10.2% (~ 13,500,000 households) in 2021 to 12.8% (~ 17,000,000 households) in 2022 and most recently 13.5% (~ 18,000,000 households) in 2023. Food insecurity is associated with various health conditions and behaviors that raise the risk of cardiovascular disease (CVD). Little is known about whether the associations between food insecurity and CVD risk factors among U.S. adults differ by gender and race/ethnicity. METHODS: The 2017-2018 National Health and Nutrition Examination Survey dataset was accessed for a cross-sectional study on the associations between food insecurity and six CVD risk factors among U.S. adults. Food insecurity was measured with the 10-item Adult Food Security Survey Module. General linear models were used to analyze the associations between food insecurity and high blood pressure, high cholesterol, diabetes, cigarette smoking, sedentary time, and body mass index (BMI). Moderation analyses examined differences in the association between food insecurity and CVD risk factors by gender and race/ethnicity. RESULTS: Food insecurity was positively associated with high blood pressure (B = 0.104, p = 0.04), diabetes (B = 0.087, p = 0.006), and cigarette smoking (B = 0.239, p = 0.002); and food insecurity was negatively associated with sedentary time (B=-0.765, p = 0.02). Moderation analyses for gender revealed that women who were food insecure had greater BMI than men who were food insecure (B = 2.284, p = 0.02). Moderation analyses for race/ethnicity determined that, compared to White adults with food insecurity, high blood pressure rates were lower among Asian (B=-0.164, p = 0.04) and Black (B=-0.153, p = 0.04) adults with food insecurity, high cholesterol rates were greater among Latino adults with food insecurity (B = 0.168, p = 0.04), and cigarette smoking rates were lower among Black (B=-0.246, p = 0.03) and Latino (B=-0.380, p = 0.006) adults with food insecurity. CONCLUSIONS: This research produced useful insight into how food insecurity relates to conditions and behaviors that increase CVD risk. Evidence from this study can inform both longitudinal and prevention efforts aimed at investigating food insecurity as both a harmful social determinant of health and a potential predictor of CVD risk among U.S. adults. TRIAL REGISTRATION: N/A.