The impact of supplemental nutrition assistance participation, and food security on diabetes-related mortality
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Abstract
Food insecurity has been a rising issue for many people in the United States and is an ongoing public health concern. Every day, food insecurity not only affects diets, it is also associated with increased risk of chronic disease and death. Households facing food insecurity may also experience elevated rates of type 2 diabetes and its health complications. National food assistance initiatives, such as Supplemental Nutrition Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are programs that help reduce food insecurity. Although these programs exist to help individuals facing food insecurity, it has not been thoroughly studied whether these programs slow diabetes-related mortality. The purpose of this study is to explore the association between food insecurity and food assistance participation with diabetes-related mortality among adults in the United States.
This study uses a retrospective design incorporating National Health and Nutrition Examination Survey (NHANES) cycles from 1999 to 2018 with mortality follow-up through linkage to the National Death Index through the end of 2019. Participants aged 18 years and older in NHANES were included in this study. Key variables include household food security status, participation in WIC, and diabetes-related mortality outcomes. Covariates include sex, race/ethnicity, education, income-to-poverty ratio, family size, and health indicators such as body mass index (BMI), hypertension, and glycosylated hemoglobin (HbA1c). Analyses adjusted for complex survey design were performed using the survey and srvyr packages in R. Descriptive statistics were generated to compare participant characteristics between levels of food security and receipt of WIC. Kaplan-Meier survival curves were used to illustrate survival across levels of WIC participation and household food security, and Cox proportional hazards regression models were used to estimate associations with diabetes-related mortality.
Preliminary descriptive analyses suggest that food-insecure adults who participate in food assistance programs differ in demographic and health characteristics compared to non-participants. Ongoing analyses will determine whether participation in food assistance is associated with a decrease in diabetes-related mortality, after adjusting for socioeconomic and health factors.
The findings will contribute to understanding how public nutrition programs influence chronic disease outcomes and serve as a guide for future strategies to reduce health disparities for vulnerable populations.
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Introduction -- Review of literature -- Methods -- Results -- Discussion
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M.S. (Master of Science)