Keck School of Medicine, University of Southern California, Los Angeles (M.A.K.-T., A.T.).
University of California, San Francisco (B.O.).
Stroke. 2022 Nov;53(11):3369-3374. doi: 10.1161/STROKEAHA.122.038574. Epub 2022 Jul 7.
Food insecurity (FI)-lack of consistent access to food due to poor financial resources-limits the ability to eat a healthy diet, which is essential for secondary stroke prevention. Yet, little is known about FI in stroke survivors.
Using data from the US National Health and Nutrition Examination Survey from 1999 to 2015, we analyzed the prevalence, predictors, and temporal trends in FI among adults with and without self-reported prior stroke in this cross-sectional study. Age-standardized prevalence estimates were computed by self-reported history of stroke over survey waves. Multivariable logistic regression models were performed for the National Health and Nutrition Examination Survey participants who had a prior stroke to identify independent predictors of FI by self-reported history of stroke.
Among 48 242 adults ≥20 years of age, 1877 self-reported history of stroke. FI was more prevalent among people with prior stroke (17%) versus those without prior stroke (12%; <0.001). Prevalence of FI increased over time from 7.8% in 1999 to 42.1% in 2015 among stroke survivors and from 8% to 17% among individuals without prior stroke (<0.001). The age-standardized prevalence of FI over the entire time was 24% among stroke survivors versus 11% among individuals without prior stroke (<0.001). In the adjusted model, younger age (adjusted odds ratio [aOR], 0.96 [0.95-0.97]; <0.01), Hispanic ethnicity (aOR, 2.12 [1.36-3.31]; <0.01), lower education (aOR, 1.67 [1.17-2.38]; <0.01), nonmarried status (aOR, 1.49 [1.01-2.19]; =0.04), and poverty income ratio <130% (aOR, 3.78 [2.55-5.59]; <0.01) were associated with FI in those with prior stroke.
One in 3 stroke survivors reported FI in 2015, nearly double the prevalence in those without stroke. Addressing the fundamental drivers of FI and targeting vulnerable demographic groups may have a profound influence on stroke prevalence.
由于经济资源匮乏导致无法稳定获得食物，食物不安全感（FI）限制了人们食用健康饮食的能力，而健康饮食对于二级中风预防至关重要。然而，人们对中风幸存者的食物不安全感知之甚少。
本横断面研究使用了 1999 年至 2015 年美国国家健康与营养调查的数据，分析了患有和不患有自我报告中风史的成年人中 FI 的流行率、预测因素和时间趋势。通过报告中风史的调查波，计算出年龄标准化的流行率估计值。对有中风史的国家健康与营养调查参与者进行多变量逻辑回归模型分析，以确定自我报告中风史的 FI 的独立预测因素。
在 48242 名≥20 岁的成年人中，有 1877 人报告有中风史。与无中风史者（12%；<0.001）相比，有中风史者（17%）的 FI 更为普遍。在中风幸存者中，FI 的患病率从 1999 年的 7.8%上升到 2015 年的 42.1%，而在无中风史者中，FI 的患病率从 8%上升到 17%（<0.001）。整个时期中风幸存者的 FI 年龄标准化流行率为 24%，而无中风史者为 11%（<0.001）。在调整模型中，年龄较小（调整后的优势比[OR]，0.96[0.95-0.97]；<0.01）、西班牙裔（OR，2.12[1.36-3.31]；<0.01）、受教育程度较低（OR，1.67[1.17-2.38]；<0.01）、未婚（OR，1.49[1.01-2.19]；=0.04）和贫困收入比<130%（OR，3.78[2.55-5.59]；<0.01）与有中风史者的 FI 相关。
2015 年，有三分之一的中风幸存者报告存在 FI，几乎是无中风史者的两倍。解决 FI 的根本驱动因素并针对弱势群体可能会对中风的流行率产生深远影响。
