Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
J Gen Intern Med. 2021 Jun;36(6):1638-1647. doi: 10.1007/s11606-020-06492-9. Epub 2021 Jan 6.
Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity.
To determine the association between food insecurity and several validated HRQoL instruments in US adults.
Cross-sectional.
US adults (age ≥ 18), weighted to be nationally representative.
Food insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D).
In December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% self-identified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p < .0001 for all). The magnitude of the difference between food-insecure and food-secure participants was largest with the SF-6D, EQ-5D, and PROPr; among individual PROMIS domain scores, the largest difference was for ability to participate in social roles.
Food insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.
2018 年，美国有超过 3700 万人面临粮食不安全问题，即无法获得足够的食物来维持积极健康的生活。粮食不安全可能与较差的健康相关生活质量（HRQoL）相关，但在具有代表性的全国性样本中，这一关联尚未用经过验证的工具进行衡量。鉴于人们越来越关注了解粮食不安全在健康结果中的作用，了解哪些 HRQoL 衡量标准最能反映那些粮食不安全人群的体验将很有帮助。
确定美国成年人中粮食不安全与几种经过验证的 HRQoL 工具之间的关联。
横断面研究。
年龄≥18 岁的美国成年人，加权以具有全国代表性。
采用美国农业部家庭粮食安全调查模块中的三个项目评估粮食不安全情况。使用 PROMIS-Preference（PROPr）评估 HRQoL，其中包含 7 个 PROMIS 域、自我报告的健康状况（SRH）、Euroqol-5D-5L（EQ-5D）、健康效用指数（HUI）和简短形式-6D（SF-6D）。
2017 年 12 月，有 4142 人完成了调查的至少一部分（31%的回复率），其中 4060 人（98.0%）报告了粮食安全信息。在调查参与者中，51.7%是女性，12.5%自我认定为黑人，15.8%是西班牙裔，11.0%没有高中文凭。14.1%的受访者报告粮食不安全。在调整后的分析中，粮食不安全与所有工具和 PROMIS 域的 HRQoL 较差相关（所有 P <.0001）。在食物不安全和食物安全参与者之间的差异最大的是 SF-6D、EQ-5D 和 PROPr；在个别 PROMIS 域评分中，差异最大的是参与社会角色的能力。
粮食不安全与较差的 HRQoL 密切相关，在食物安全和食物不安全个体之间的差异最好使用 SF-6D、EQ-5D 和 PROPr 来衡量。未来的工作应该开发一种专门的工具来衡量粮食不安全干预措施中 HRQoL 的变化。
