Food Insecurity Is Associated with Behavioral Health Diagnosis Among Older Primary Care Patients with Multiple Chronic C
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Division of General Internal Medicine and the Multiethnic Health Equity Research Center, UCSF, San Francisco, CA, USA; 2Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA; 3Division of General Internal Medicine, UCSF/ZSGH, San Francisco, USA; 4Division of Geriatrics, UCSF, San Francisco, USA; 5Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05569-4 © Society of General Internal Medicine 2019
INTRODUCTION
Food insecurity, defined as uncertain or limited access to nutritionally adequate and safe foods, can negatively impact health outcomes and healthcare utilization of those with multiple chronic conditions (MCC) 1–3. However, few studies have examined food insecurity among older adults with MCC in primary care. This study examines sociodemographic and clinical factors associated with food insecurity among older adults with MCC in primary care in order to direct food insecurity screening efforts to high-risk populations.
METHODS
From March to December 2016, we conducted a crosssectional telephone survey of adults aged 60 years or older receiving care from an urban academic primary care practice. Inclusion criteria included fluency in English, Spanish, or Chinese (Cantonese/Mandarin); at least two concurrent chronic conditions based on diagnosis codes from the Elixhauser Comorbidity Index 4; and at least one clinic visit in the last year. We identified eligible participants from the electronic health record (EHR), selected participants using random clinic sampling stratified by race/ethnicity, and recruited participants using an opt-out letter. The survey included the 10-item U.S. Adult Food Security Survey Module (food insecurity defined as 3+ affirmative responses), education, employment, annual household income, English proficiency, cost-related This work was presented as a poster presentation at the Society of General Internal Medicine Annual Meeting on April 12, 2018 and at the American Geriatrics Society Annual Meeting on May 4, 2018. Received November 6, 2019 Revised November 6, 2019 Accepted November 20, 2019
medication non-adherence, self-reported health status, and utilization of community food resources and the Supplemental Nutrition Assistance Program (SNAP). We linked survey responses to the following variables from the EHR: age, sex, race/ethnicity, insurance type, preferred language, ICD-10 diagnosis codes, and healthcare utilization. We conducted bivariate analyses and a parsimonious multivariate logistic regression model, adjusting for socio-demographic and clinical factors that were significantly different between older adults with and without food insecurity. We did not include the number of medications since it was moderately correlated with the number of chronic conditions (r = 0.33).
RESULTS
The prevalence of food insecurity in this sample of older adults with MCC (n = 475) was 8.2%. The food insecure participants were younger (mean 68 versus 73 years old) and more likely to ident
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