Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes

• Published in: PloS one 2022-12, Vol.17 (12), p.e0278650
• Main Authors: Mosley-Johnson, Elise, Walker, Rebekah J, Nagavally, Sneha, Hawks, Laura, Bhandari, Sanjay, Trasser, Hannah, Campbell, Jennifer A, Egede, Leonard E
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adults; Behavior; Biology and Life Sciences; Care and treatment; Comorbidity; Demographics; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetics; Dwellings; Earth Sciences; Education; Emergency medical care; Evaluation; Food; Food and nutrition; Food Insecurity; Food quality; Food security; Food supply; Health aspects; Health care access; Health Education; Health risks; Health surveillance; Hispanic Americans; Homes and haunts; Housing; Humans; Influence; Low income groups; Medical care; Medicine and Health Sciences; Mental health; Patient compliance; Quality management; Quality of Health Care; Quality of Life; Questionnaires; Risk analysis; Risk factors; Risk taking; Social Sciences; Surveillance systems
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0278650

Examine the relationship between food and housing insecurities, quality of care and quality of life in adults with diabetes using a nationally representative data source. Data from 39,604 adults with diabetes who indicated if they experienced food and/or housing insecurity in the Behavioral Risk Factor Surveillance System (2014, 2015, 2017) was analyzed. Outcomes included quality of care (HbA1c test, eye exam, diabetes education, foot check) and quality of life (general health status, poor physical and mental health days, poor overall health days). Logistic models were run for each quality of care measure and linear models were run for each quality of life measure adjusting for socio-demographics, insurance status, and comorbidity count. 35.6% of adults with diabetes reported housing insecurity, 31.8% reported food insecurity, and 23.4% reported both. After adjustment, food and housing insecurity was significantly associated with lower odds of having an eye exam (housing:0.73, 95%CI:0.63,0.85; food:0.78, 95%CI:0.67,0.92; both:0.69, 95%CI:0.59,0.82), worse general health status (housing:-0.06 95%CI:-0.11,-0.01; food:-0.16, 95%CI:-0.21,-0.10; both:-0.14, 95%CI:-0.20,-0.09), and an increased number of poor mental health days (housing:1.73, 95%CI:0.83,2.63; food:2.08, 95%CI:1.16,3.00; both:1.97, 95%CI:1.05,2.90). Food insecurity was also associated with lower odds of receiving diabetes education (0.86, 95%CI:0.74,0.99) and an increased number of poor physical health days (0.95, 95%CI:0.14,1.76). Changes to our healthcare delivery system are critical to improving standards of care and quality of life in all populations and may require a shift towards consideration of overlapping social risk factors rather than the siloed approach currently used.