Study data published in JAMA Internal Medicine highlight the significant burden that food insecurity poses to Medicare beneficiaries. Food insecurity was particularly prevalent among individuals under 65 years of age and those with dual Medicaid enrollment, low income, comorbid chronic conditions, depression, or anxiety.
Investigators abstracted data from the 2016 Medicare Current Beneficiary Survey, which was administered between July 25, 2016 and August 31, 2017. The survey included a 6-item food security questionnaire in which participants who endorsed 2 or more items were considered “food insecure.” Health-related covariates were captured by self-report; demographic information was gathered using the Medicare & Medicaid Services administrative database. Analyses were stratified by age, with respondents younger than 65 years and those age 65 years or older considered separately. Logistic regression analyses were performed to calculate the odds of food insecurity among enrollee subgroups.
A total of 9674 community-dwelling adults with continuous 2016 Medicare enrollment contributed data to the analysis. Among enrollees younger than 65 years, 38.3% (95% confidence interval [CI], 34.5%-42.1%) reported food insecurity. Several risk factors for food insecurity also were common in this age group, including income less than $15k per year, having 4 or more chronic conditions, and depression. Among adults 65 years or older, 9.1% (95% CI, 8.3%-9.8%) reported food insecurity, with higher rates observed among those with income less than $15k per year (25.8%; 95% CI, 22.9%-28.7%) and Medicaid dual enrollment (33.6%; 95% CI, 30.5%-36.7%). Per multivariate logistic regression, the 3 lowest income brackets (<$15k; $15k-$25k; $25k-$50k) were each associated with food insecurity when compared with the highest bracket (>$50k). For individuals under 65 years, having an income less than $15k was associated with 8-fold higher odds of food insecurity compared with an income more than $50k (95% CI, 3.32-18.71). Among enrollees aged 65 years or older, the odds ratio [OR] of food insecurity for those earning less than $15k versus more than $50k was 12.88 (95% CI, 7.32-20.41). Food insecurity also was associated with having 4 or more chronic conditions (<65 years: OR, 2.07; 95% CI, 1.30-3.28; ≥65 years: OR, 1.91; 95% CI, 1.33-2.76); depression (<65 years: OR, 2.65; 95% CI, 1.75-4.00; ≥65 years: OR, 1.60; 95% CI, 1.19-2.15); or anxiety (<65 years: OR, 1.72; 95% CI, 1.20-2.47; ≥65 years: OR, 1.44; 95% CI, 1.02-2.04).
In secondary models constructed for individual medical conditions, diabetes was associated with a borderline significant association with food insecurity (OR, 1.34; 95% CI, 1.03-1.75) in enrollees aged 65 years or older. In secondary models that assessed supplemental insurance versus employer-sponsored insurance, Medicaid remained significantly associated with food insecurity in the older age bracket (OR, 3.80; 95% CI, 2.20-6.56).
A significant number of Medicare enrollees reported food insecurity: 1 in 4 of those under 65 years and 1 in 10 of those 65 years or older. Additional risk factors for food insecurity included low income, Medicaid dual enrollment, chronic condition comorbidity, depression, and anxiety. Because the study was a cross-sectional analysis, causality could not be established. Even so, these data underscore the importance of “[intensified] focus on social determinants of health,” according to the study authors. Interventions that target dual enrollees and individuals with other risk factors may be essential to reducing the burden of food insecurity.
Madden JM, Shetty PS, Zhang F, et al. Risk factors associated with food insecurity in the Medicare population [published online September 30, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2019.3900