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Is food insufficiency associated with health status and health care utilization among adults with diabetes?

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Abstract

OBJECTIVES: Preliminary studies have shown that among adults with diabetes, food insufficiency has adverse health consequences, including hypoglycemic episodes and increased need for health care services. The purpose of this study was to determine the prevalence of food insufficiency and to describe the association of food insufficiency with health status and health care utilization in a national sample of adults with diabetes.

METHODS: We analyzed data from adults with diabetes (n=1,503) interviewed in the Third National Health and Nutrition Examination Survey. Bivariate and multivariate analyses were used to examine the relationship of food insufficiency to self-reported health status and health care utilization.

RESULTS: Six percent of adults with diabetes reported food insufficiency, representing more than 568,600 persons nationally (95% confidence interval, 368,400 to 768,800). Food insufficiency was more common among those with incomes below the federal poverty level (17% vs 4%, P≤.001). Adults with diabetes who were food insufficient were more likely to report fair or poor health status than those who were not (63% vs 43%; odds ratio, 2.2; P=.05). In a multivariate analysis, fair or poor health status was independently associated with poverty, nonwhite race, low educational achievement, and number of chronic diseases, but not with food insufficiency. Diabetic adults who were food insufficient reported more physician encounters, either in clinic or by phone, than those who were food secure (12 vs 7, P<.05). In a multivariate linear regression, food insufficiency remained independently associated with increased physician utilization among adults with diabetes. There was no association between food insufficiency and hospitalization in bivariate analysis.

CONCLUSIONS: Food insufficiency is relatively common among low-income adults with diabetes and was associated with higher physician utilization.

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Authors and Affiliations

  1. Received from the Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, Calif.

    Karin Nelson MD, MSHS & William Cunningham MD, MPH

  2. the Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, Calif.

    Lillian Gelberg MD, MSPH

  3. School of Medicine, Department of Health Services, University of California, Los Angeles, Los Angeles, Calif.

    William Cunningham MD, MPH & Ron Andersen PhD

  4. Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, Los Angeles, Calif.

    Gail Harrison PhD

Authors
  1. Karin Nelson MD, MSHS
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  2. William Cunningham MD, MPH
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  3. Ron Andersen PhD
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  4. Gail Harrison PhD
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  5. Lillian Gelberg MD, MSPH
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Corresponding author

Correspondence to Karin Nelson MD, MSHS.

Additional information

Karin Nelson was a NRSA research fellow in the Division of General Medicine at UCLA when this study was conducted. Lillian Gelberg is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. William Cunningham is a Doris Duke Charitable Foundation Clinical Scientist.

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Nelson, K., Cunningham, W., Andersen, R. et al. Is food insufficiency associated with health status and health care utilization among adults with diabetes?. J GEN INTERN MED 16, 404–411 (2001). https://doi.org/10.1046/j.1525-1497.2001.016006404.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2001.016006404.x

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