Applications of Trajectory and Transition Modeling Methods to Characterize the Dynamic Relationship Between Food Insecurity, Health, and Health Care Use in Low-Income Older Adults in the United States

New York University, New York NY

Investigators

Abstract

PROJECT SUMMARY Food insecurity is an unmet social need associated with poorer health and higher mortality, morbidity, health care use, and health care expenditures. Among older adults in the U.S., food insecurity is of particular concern due to its recent rise in prevalence and its association with barriers to healthy aging such as nutrient deficiencies, multiple chronic conditions, functional limitations, falls, and cognitive decline. The growing number of food-insecure older adults places additional demands on health care delivery systems to provide coordinated and whole-person care that effectively and efficiently responds to the medical needs of older adults and their social context. To achieve this, providers need rigorous, longitudinal evidence addressing the short- and long-term impacts of food insecurity on older adults’ health care needs, the health and health care consequences of fluctuations in food insecurity over time, and the influence of health care use and patient characteristics on future food insecurity risk. Although research on food insecurity and health is growing, the vast majority of studies use cross-sectional designs or short follow-up periods and do not capture the transient nature of food insecurity, nor the cyclical and mutually reinforcing relationship it has with health and health care use. Moreover, there is scant evidence on longitudinal patterns of food insecurity and transitions into and out of food insecurity in older adults, and although food insecurity is more prevalent among several racial and ethnic minority groups, little is known about differences in the influence of food insecurity on health care outcomes across these groups. As a result, providers and health systems have limited knowledge of when, how, and for whom food insecurity results in changes in health and health care needs. To address these knowledge gaps, the proposed study will leverage five waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling older adults ages 50 and over, to characterize how changes in food insecurity and health care needs influence each other as individuals age and examine how these relationships vary across racial and ethnic groups. To achieve these goals, the project aims to (1) compare associations between food insecurity and changes in health and health care outcomes among white, non-Hispanic Black, and Hispanic older adults (2) identify sub-groups of low-income older adults who follow different food insecurity trajectories and the health and health care outcomes associated with each trajectory; and (3) estimate the probabilities of becoming, staying, or ceasing to be food insecure among low-income adults with different racial/ethnic identities, demographic and socioeconomic characteristics, health needs, and health care experiences. This study will employ novel applications of trajectory and transition modeling methods to improve foundational knowledge on the longitudinal relationship between food insecurity and health care use in order to inform improvements in the capacity of health care delivery systems to identify, anticipate, and intervene on the health care needs of food-insecure older adults.