Abstract
Background: This study aimed to investigate the relationship between food insecurity and physical- and mental-health-related quality of life in adults with diabetes. Methods: Using two years of national Medical Expenditure Panel Survey data (2016-2017), we investigated the relationship between food insecurity and physical-health-related (PCS) and mental-health-related (MCS) quality of life in adults with diabetes. PCS and MCS were measured with the Short-Form 12 health survey and food insecurity was measured with the USDA 10-item adult scale. Analyses were weighted to represent the US adult population. Adjusted linear regression models, including covariates of age, gender, education, race/ethnicity, marital status, region, poverty level, employment status, health insurance, and comorbidities were used. Results: After adjustment, food-insecure adults with diabetes maintained significantly lower quality of life compared to food-secure adults with diabetes (PCS: -3.44, 95%CI -4.63, -2.25; MCS: -5.37, 95%CI -6.68, -4.06). This drop in PCS was larger than the drop for chronic conditions, including arthritis (-3.77, 95%CI -5.02, -2.52), emphysema (-2.82, 95%CI -5.12, -0.53), stroke (-2.63, 95%CI -4.11, -1.15), cancer (-2.59, 95%CI -4.00, -1.17), and heart attack (2.58, 95%CI 4.68, 0.48). Similarly, the drop for MCS was larger than for chronic pain (-2.37, 95%CI -3.24, -1.50) and arthritis (-1.31, 95%CI -2.28, -0.33). Conclusions: Food insecurity was associated with a significant reduction in both physical- and mental-health-related quality of life in adults with diabetes, with a magnitude of effect greater than adjusted estimates for the drop in quality of life for key chronic conditions. Addressing food insecurity through integration of social and medical care may lead to improvements in quality of life for adults with diabetes.