Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
J Am Geriatr Soc. 2018 May;66(5):1017-1024. doi: 10.1111/jgs.15285. Epub 2018 Mar 1.
To estimate food insecurity prevalence and develop a statistical prediction model for food insecurity.
Retrospective cohort study.
Kaiser Permanente Colorado.
Adult members who completed a pre-Medicare Annual Wellness Visit survey.
Food insecurity was assessed using a single screening question. Sociodemographic and clinical characteristics from electronic health records and self-reported characteristics from the survey were used to develop the prediction model.
Of 130,208 older adult members between January 2012 and December 2015, 50,097 (38.5%) completed food insecurity screening, 2,859 of whom (5.7% of respondents) reported food insecurity. The prevalence of food insecurity was 10.0% or greater among individuals who were black or Hispanic, had less than high school education, had Medicaid insurance, were extremely obese, had poor health status or quality of life, had depression or anxiety, had impairments in specific activities of daily living, had other nutritional risk factors, or were socially isolated (all p<.001). A multivariable model based on these and other characteristics showed moderate discrimination (c-statistic = 0.74) between individuals with food insecurity and those without and 14.3% of individuals in the highest quintile of risk reported food insecurity.
Food insecurity is prevalent even in older adults with private-sector healthcare coverage. Specific individual characteristics, and a model based on those characteristics, can identify older adults at higher risk of food insecurity. System-level interventions will be necessary to connect older adults with community-based food resources.
评估食物不安全的流行程度并建立食物不安全的统计预测模型。
回顾性队列研究。
科罗拉多州 Kaiser Permanente。
完成 Medicare 年度健康访视前调查的成年会员。
使用单一筛选问题评估食物不安全。从电子健康记录中获取社会人口学和临床特征以及从调查中获取自我报告特征，用于开发预测模型。
在 2012 年 1 月至 2015 年 12 月期间的 130208 名老年会员中，有 50097 名（38.5%）完成了食物不安全筛查，其中 2859 名（受访者的 5.7%）报告食物不安全。在黑人和西班牙裔、受教育程度低于高中、拥有医疗补助保险、极度肥胖、健康状况或生活质量差、患有抑郁或焦虑、日常生活活动能力受损、有其他营养风险因素或社会孤立的个体中，食物不安全的发生率为 10.0%或更高（均 p<.001）。基于这些特征和其他特征的多变量模型显示，在有食物不安全和无食物不安全的个体之间存在中度区分（c 统计量=0.74），在风险最高的五分之一个体中，有 14.3%报告食物不安全。
即使在拥有私营部门医疗保健的老年人中，食物不安全也很普遍。特定的个体特征，以及基于这些特征的模型，可以确定食物不安全风险较高的老年人。需要进行系统层面的干预，以将老年人与社区食品资源联系起来。
