Food insecurity and social inequalities in households headed by older people in Brazil: a secondary cross-sectional analysis of a national survey

Background The presence of food insecurity in households headed by older people is related to social inequalities. The objective of this study was to analyze the prevalence and factors associated with moderate/severe food insecurity in households headed by older people. Methods A cross-sectional study based on a nationally representative sample of older adults aged ≥ 60 years was conducted using data from the 2017/2018 Family Budget Survey. In the study, moderate/severe food insecurity was the dependent variable, with food insecurity assessed with the Brazilian Household Food Insecurity Measurement Scale. Prevalence and odds ratio estimates were generated with 99% confidence intervals. Data analysis was performed using STATA software. Findings A total of 16,314 households headed by older people were identified. Approximately 10.1% of these households were in the moderate/severe range for food insecurity. The majority are female (11.9%)and self-declared indigenous people (25.5%), with a lack of schooling (18.3%) and a per capita income of up to half of one minimum wage (29.6%). The analysis model found that color/race, region, schooling, per capita household income, and social benefits received in the household were statistically significant factors (p value < 0.01). Conclusion Moderate/severe food insecurity in households headed by older people is associated with the pronounced social inequalities present in Brazil, and these findings intensify the need for additional study of the challenges faced by this age group. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-16332-0.


Brazilian Household Food Insecurity Measurement Scale Escala Brasileira de Insegurança Alimentar
Direct measurement scales of Food Insecurity (FI), such as the Brazilian Household Food Insecurity Measurement Scale, provide strategic information for the management of policies and social programs because they allow both identifying and quantifying the social groups at risk of FI as well as its determinants and consequences.It is a tool with an excellent cost-effectiveness ratio that has been used since the 1990s in several countries and whose application and analysis have shown to present common aspects to different sociocultural contexts and that represent the degrees of severity of FI: 1) psychological componentanxiety or doubt about the future availability of food in the house to meet the needs of the residents; 2) food qualityimpairment of socially established preferences about food and its variety in the household stock; 3) quantitative reduction of food among adults; 4) quantitative reduction of food among children; 5) hungerwhen someone goes the whole day without eating due to lack of money to buy food (COATES, 2006;PÉREZ-ESCAMILLA;SEGALL-CORRÊA, 2008;SWINDALE;BILINSKY, 2006).Based on the perception of the household's experience in the last 90 days, the Brazilian Household Food Insecurity Measurement Scale points to one of the following levels of FI experienced by households: The EBIA analysis is based on a final score gradient resulting from the sum of affirmative responses to 14 questions.This score fits into the cutoff points (Table S2), which are equivalent to the theoretical constructs about food security, as shown in table S1.
Table S2.Cutoff points for households, with and without children under 18 years of age, according to food security situation.

Food security situation Cutoff points for households With children under 18
No under 18 years old Food security 0 0 Mild food insecurity 1-5 1-3 Moderate food insecurity 6-9 4-5 Severe food insecurity 10-14 6-8 These algorithms were updated during the technical workshop for the analysis of the EBIA, promoted at the time by the Secretariat for Evaluation and Information Management, of the then Ministry of Social Development and Fight against Hunger.Held between the 16th and 17th of August 2010, in Brasilia, the workshop had the participation of the research group that elaborated the EBIA.The technical group present at the workshop also approved some updates to the EBIA, which now has 14 questions in its composition.The component questions of the EBIA introduced in the 2018 Family Budget Survey can be seen in Table S3.
Table S3.Questions from the Brazilian Household Food Insecurity Measurement Scale.

Numbering Question 1
In the past three months, have residents of this household been concerned that food would run out before they could buy or receive more food? 2 In the three months, did the food run out before the residents of this household could afford to buy more food?3 In the last three months, did the residents of this household run out of money to have a healthy and varied diet? 4 In the last three months, did the residents of this household eat only a few types of food they still had because they ran out of money? 5 In the last three months, did any household member aged 18 or over miss a meal because there was no money to buy food?6 In the past three months, did any household member, age 18 or older, ever eat less than they thought they should because there was no money to buy food?7 In the past three months, did any household member aged 18 or over ever feel hungry but not eat because there was no money to buy food?8 In the past three months, did any household member aged 18 or over ever eat just one meal a day or go a whole day without eating because there was no money to buy food?9 In the last three months, did any resident under 18 years of age ever fail to eat a healthy and varied diet because there was no money to buy food? 10 In the past three months, did any household member under the age of 18 ever eat less than they should because there was no money to buy food?11 In the last three months, has the amount of food in the meals of any resident under 18 years of age been reduced because there was no money to buy food?12 In the last three months, did any resident under 18 years of age ever skip a meal because there was no money to buy food?13 In the past three months, did any household member under 18 years of age ever feel hungry but did not eat because there was no money to buy food?14 In the last three months, did any resident under 18 years of age ever eat just one meal a day or go without food for a whole day because there was no money to buy food?
The structure of the scale with its questions constituting conceptual groupings and the described form of classification are conditions that allow estimating the prevalence of FS or FI in households in an adequate and scientifically tested manner, therefore, the use of analytical procedures to be used is not recommended.From one or more of your questions, alone, or any alternative.These approaches would provide results that are not consistent.

Table S1 . Description of degrees of food security and insecurity. Food security situation Description
The Brazilian scale is an adapted and validated version of the one developed by the United States Department of Agriculture (USDA) in the mid-1990s.The Brazilian Household Food Insecurity Measurement Scale validation process was conducted by groups of researchers from universities located in the five regions of the country, coordinated by the Department of Collective Health of the State University of Campinas -UNICAMP, and required qualitative and quantitative studies to be carried out in urban and rural areas of the five major regions of the country, between 2003 and 2004.In 2003, the first use of the EBIA was provided by the National Council for Scientific and Technological Development -CNPq, which financed a set of studies, through a project coordinated by UNICAMP, with the application of a scale to estimate the prevalence of AS in several Brazilian cities.In 2004, it was incorporated into the food security supplement of the National Household Sample Survey -PNAD.In 2006, this diagnosis was updated through the use of the EBIA in the National Survey of Demography and Health of Children and Women -PNDS, of the Ministry of Health.The results of 2004 PNAD and 2006 PNDS confirm that FI is directly related to other socioeconomic factors and the composition of the household (such as, for example, the presence of residents under 18 years of age, the number of residents, gender or race of head of household, and household income).Therefore, it is advisable that the Brazilian Household Food Insecurity Measurement Scale questions are part of data collection instruments that also include socioeconomic, cultural and other variables that are deemed relevant for a more comprehensive characterization of the factors that affect the FS of families, as has been done by the Brazilian Institute of Geography and Statistics in specific PNAD supplements on the subject and, for the first time, as an integral part of the 2018 Family Budget Survey Assessment of Living Conditions questionnaire.