Is food insufficiency associated with health status and health care utilization among adults with diabetes?
OBJECTIVE
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 < or = .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.
Nelson
K
K
Division of General Internal Medicine and Health Services Research, Department of Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. karin.nelson@med.va.gov
Cunningham
W
W
Andersen
R
R
Harrison
G
G
Gelberg
L
L
D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D006815:Hunger; D008297:Male; D009748:Nutrition Disorders / Q000453:epidemiology*; D015995:Prevalence; D012959:Socioeconomic Factors