Oladele Carol R, Khandpur Neha, Galusha Deron, Nair Sanya, Hassan Saria, Wambugu Vivien, Martinez-Brockman Josefa, Nunez-Smith Marcella, Perez-Escamilla Rafael
Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America.
Wageningen University and Research, Wageningen, The Netherlands.
PLOS Glob Public Health. 2025 May 5;5(5):e0003296. doi: 10.1371/journal.pgph.0003296. eCollection 2025.
Limited evidence exists on the association between food insecurity (FI) and the hypertension care cascade in the Caribbean despite the high burden of both. The objective of this study is to examine the relationship between FI and hypertension prevalence, awareness, and control in the Eastern Caribbean. We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (n = 2961). Food insecurity was measured using the Latin American and Caribbean Food Security Scale (ELCSA) and classified as secure, mild, moderate, and severe. Hypertension was defined using guidelines from the Seventh Report of the Joint National Committee on Prevention and Caribbean Health Research Council. Poisson regression was used to estimate prevalence ratios for the association between FI and hypertension prevalence, awareness, and control, adjusting for covariates. Overall prevalence of FI was 28 percent in our sample. Seventeen percent experienced mild, 6 percent moderate, and 4 percent experienced severe FI. Fifty-eight percent had hypertension, 65 percent were aware of their hypertension, and among those aware, 56 percent had uncontrolled hypertension. Model results showed no association between FI and hypertension prevalence and awareness. Results for control showed moderate FI (PR = 1.33, CI = 1.09-1.64) and severe FI (PR = 1.30, CI = 1.05-1.62) were associated with 30 percent higher prevalence of uncontrolled hypertension compared to those who are food secure. Sex-stratified results showed women with moderate (PR = 1.39, CI = 1.13-1.71) and severe FI (PR = 1.41, CI = 1.16-1.72) had 40 and 41 percent higher prevalence of uncontrolled hypertension compared to food secure women, respectively. Results for men were not statistically significant. Findings align with prior evidence of greater FI prevalence among women and associations with hypertension control. Nutrition policies are needed to reduce FI prevalence and increase access to affordable, nutritious foods. Results warrant further studies to understand sex differences in FI prevalence and the impact on hypertension.
尽管粮食不安全（FI）和高血压在加勒比地区的负担都很高，但关于两者之间关联的证据有限。本研究的目的是探讨东加勒比地区粮食不安全与高血压患病率、知晓率和控制率之间的关系。我们对东加勒比健康结果研究网络队列研究（n = 2961）的基线数据（2013 - 2018年）进行了横断面分析。使用拉丁美洲和加勒比粮食安全量表（ELCSA）测量粮食不安全情况，并将其分为安全、轻度、中度和重度。高血压根据美国预防、检测、评估与治疗高血压联合委员会第七次报告及加勒比健康研究委员会的指南进行定义。采用泊松回归估计粮食不安全与高血压患病率、知晓率和控制率之间关联的患病率比，并对协变量进行调整。在我们的样本中，粮食不安全的总体患病率为28%。17%的人经历轻度粮食不安全，6%的人经历中度粮食不安全，4%的人经历重度粮食不安全。58%的人患有高血压，65%的人知晓自己患有高血压，在知晓的人群中，56%的人高血压未得到控制。模型结果显示粮食不安全与高血压患病率和知晓率之间无关联。关于控制情况的结果显示，与粮食安全的人相比，中度粮食不安全（PR = 1.33，CI = 1.09 - 1.64）和重度粮食不安全（PR = 1.30，CI = 1.05 - 1.62）人群高血压未得到控制的患病率高30%。按性别分层的结果显示，与粮食安全的女性相比，中度（PR = 1.39，CI = 1.13 - 1.71）和重度粮食不安全（PR = 1.41，CI = 1.16 - 1.72）的女性高血压未得到控制的患病率分别高40%和41%。男性的结果无统计学意义。研究结果与先前关于女性中粮食不安全患病率更高以及与高血压控制存在关联的证据一致。需要制定营养政策以降低粮食不安全患病率，并增加获得负担得起的营养食品的机会。研究结果值得进一步研究，以了解粮食不安全患病率的性别差异及其对高血压的影响。
