Department of Epidemiology College of Public Health University of Iowa Iowa City Iowa.
Department of Nutrition and Food Hygiene School of Public Health Medical College Wuhan University of Science and Technology Wuhan China.
J Am Heart Assoc. 2020 Oct 20;9(19):e014629. doi: 10.1161/JAHA.119.014629. Epub 2020 Sep 25.
Background Food insecurity is a global leading public health challenge that affects not only developing countries but also developed countries, including the United States. About 50 million Americans are food insecure. In this study we examined the associations of the adult food insecurity with all-cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods and Results We included 27 188 US adults (age ≥40 years of age) who participated in the US National Health and Nutrition Examination Survey from 1999 to 2014. Food insecurity status was assessed using the Food Security Survey Module developed by the US Department of Agriculture. Mortality from all causes and cardovascular disease was ascertained through data linkage to the National Death Index through December 31, 2015. We used multivariable Cox proportional hazards regression with sampling weights to estimate hazard ratios (HRs) and 95% CIs of all-cause and cardiovascular disease mortality, according to food security status. During 205 389 person-years of the period, 5039 deaths occurred, including 1084 cardiovascular disease deaths. After adjustment for age, sex, race/ethnicity, education, income, and dietary and lifestyle factors, participants with very low food security had higher risk of all-cause and cardiovascular disease mortality, with multivariable-adjusted HRs of 1.32 (95% CI, 1.07-1.62), and 1.53 (95% CI, 1.04-2.26), respectively, compared with those with high food security. Conclusions Food insecurity is significantly associated with increased risk of excess death from cardiovascular disease and all causes in US adults.
食品不安全是一个全球性的主要公共卫生挑战，不仅影响发展中国家，也影响发达国家，包括美国。约有 5000 万美国人面临食品不安全问题。本研究在美国成年人的全国代表性样本中，调查了成年人的食品不安全状况与全因和心血管疾病死亡率之间的关联。
我们纳入了 27188 名美国成年人（年龄≥40 岁），他们参加了 1999 年至 2014 年期间的美国国家健康和营养调查。使用美国农业部开发的食品安全调查模块评估食品不安全状况。通过与国家死亡指数的数据链接，确定所有原因和心血管疾病的死亡率，截至 2015 年 12 月 31 日。我们使用带有抽样权重的多变量 Cox 比例风险回归来估计全因和心血管疾病死亡率的风险比（HRs）和 95%置信区间，根据食品安全状况。在 205389 人年的期间内，发生了 5039 例死亡，包括 1084 例心血管疾病死亡。在调整年龄、性别、种族/族裔、教育、收入以及饮食和生活方式因素后，极低收入保障食品安全的参与者发生全因和心血管疾病死亡的风险更高，多变量调整后的 HR 分别为 1.32（95%CI，1.07-1.62）和 1.53（95%CI，1.04-2.26），与高食品安全相比。
食品不安全与美国成年人因心血管疾病和其他原因导致的超额死亡风险显著相关。
