Abstract
Severe food insecurity (SFI) is a critical concern in India, yet few studies have highlighted national and state trends among Indian adults. Utilizing data from 63,525 adults aged 45 and above from the Longitudinal Aging Study in India (2017-18), we present noteworthy geographic and sociodemographic patterns in the distribution of SFI. We estimate the national prevalence to be 6.2% (95% CI: 5.6, 6.8). Madhya Pradesh had the highest prevalence of SFI (10.3%), followed by Jharkhand, Tamil Nadu, and Bihar. Conversely, Nagaland, Goa, Lakshadweep, and Arunachal Pradesh had the lowest prevalence (all under 2.0%). Living in a rural area, being widowed, belonging to a Scheduled Caste, and being Muslim were positively associated with reporting SFI. Additionally, those in the middle and richer household monthly per capita expenditure quintiles, with 6-9 years of schooling, who resided in the country's northern and northeastern regions, or who had never worked for more than three months in their lifetime, were less likely to report SFI. We also find that geography and socioeconomic status synergistically affect SFI. Specifically, adults with lower levels of education were at a greater risk of SFI in rural areas, relative to urban areas, and the Central and East regions of India, relative to the North. Our findings highlight the need for robust state-level policies to ensure equitable access to affordable, high-quality food for all Indian adults, particularly for those belonging to at-risk groups.