Food insecurity and mortality risk among adults with Chronic Kidney Disease: A longitudinal cohort study of NHANES

Chronic Kidney Disease (CKD) and food insecurity are widely prevalent among adult Americans, but the long term impact of food insecurity on CKD outcomes is not well explored. Thus, the purpose of this investigation was to prospectively assess the impact of food insecurity on mortality risk among American adults with CKD.

The National Health and Nutrition Examination Survey (NHANES, years 1999 to 2010) data on adults ≥ 50 years of age were analyzed by prospectively following up these individuals for mortality analysis through December 31, 2019, using the National Death Index (NDI) death certificate records. The study population was stratified based on CKD or food insecurity status and multiple Cox regression models were constructed to examine group differences in the risk of mortality among people with CKD (based on their food security status) after adjusting for sociodemographic and health-related characteristics of participants. Mortality was estimated with hazard ratios (HR, 95%CI).

A total of 13,512 NHANES participants were included in the study sample with more than a fifth (21.5%) living with CKD and 6.58% reporting food insecurity. Overall, individuals with CKD had a higher risk of mortality (HR = 1.46, 95% CI = 1.19–1.79) upon follow-up. Individuals with food insecurity but without CKD did not have a higher risk of mortality. However, individuals with CKD and no food insecurity (HR = 1.37, 95% CI = 1.10–1.71) or those with both CKD and food insecurity (HR = 2.28, 95% CI = 1.34–3.88) had a significantly higher risk of mortality. Across all group comparisons, age and smoking were the two factors consistently influencing the relationship between CKD, food insecurity, and mortality.

Food insecurity and smoking must be considered as critical components for interventions aimed at reducing CKD progression and premature mortality among high-risk populations.