HSCI 617: Journal Club Paper

Health Care
Epidemiology
RACE AND SEX DIFFERENCES IN THE ASSOCIATION
BETWEEN FOOD INSECURITY AND TYPE 2 DIABETES

Jerry Aneke, Aleka Arredondo, Suborna Bhattacharjee,

Anabel Castaneda, Niani Coker, and Farhan Danish
Learning Objectives:
● Develop public health communication skills to relay
epidemiologic data
● Evaluate and synthesize current literature
● Apply knowledge of epidemiologic principles/methods to make
recommendations regarding the validity of epidemiologic data
Journal Article

RACE AND SEX DIFFERENCES IN THE ASSOCIATION BETWEEN FOOD

INSECURITY AND TYPE 2 DIABETES

Sabrina Strings, PhD; Yamini K. Ranchod, PhD;

Barbara Laraia, PhD, MPH, RD;
Amani Nuru-Jeter, PhD, MPH

Ethnicity & Disease, Volume 26, Number 3, Summer 2016

 Introduction

● Objective: To examine whether the relationship

between food insecurity (FI) and type 2 diabetes
(T2D) varies by race/ethnicity and sex.

● Hypothesis: There would be a strong relationship

between race/ethnicity, sex/gender, and food
security, and the relationship would be stronger with
women and minorities than with men and whites.
 ● Which race or ethnic group do you think
is most impacted by food insecurity
linked to T2D?

● Prevalence of diabetes among white and

black women is less than their male

Ice Breaker
counterparts however, for latino women
prevalence is slightly higher than in men.
Can you list some gender specific social
determinants that might be responsible
for this?

● What may be some of the distal factors

that are linked to food insecurity for
minority men and women?
Who Are They?
● Low income adults participating in the 2009 and
2011 waves of the California Health Interview
Survey (CHIS) (N=22,596).

● With a focus on Black, Latino, and White

race/ethnicity .
Method

● Used secondary data from the California Health

Interview Survey (CHIS) 2009 and 2011 adult data files.
○ Adults at or below 200% of the federal poverty level
○ Final sample size = 22,596
■ Black = 1486, Latino = 10,118 and White =
10,992
● Type II Diabetes was the binary outcome variable for this
study.
● CHIS is a random dialed telephone survey that was done
in order to order to understand the health of California’s
population.
Statistical
MULTIVARIATE LOGISTIC
Analysis REGRESSION
● Multivariate logistic
regression was used to
observe the relation between
the study variables. THREE WAY INTERACTION
● A three-way interaction term TO DETERMINE RELATION
was added to determine if the
relation between food BETWEEN FI and T2D
insecurity and diabetes
differed by race/ethnicity and
sex/gender.
● All analysis were conducted
using SAS version 9.3. SAS 9.3
Findings
● The study shows positive associations between low food security and T2D for
White men, and between very low food security and T2D for White women.
● In Latinas, the study observed positive associations between both low food
security and very low food security and T2D.
● The study did not observe any associations between FI and T2D in Latino men, or
African American women and men.
● Food insecurity was associated with a 90% increase in the odds of diabetes among
White men.
● Very low food security was associated with a 70% increase in the odds of diabetes
among White women and 80% increase in the odds of diabetes among Latinas.
 Study Strengths

● This was one of the few studies that identified the role of sex/gender as a relation
between food insecurity and type 2 diabetes.
● It lays emphasis on racial/ethnic roles as a link between food insecurity and type 2
diabetes.
● The study recognizes patterns with specific populations and the significance of food
affordability amongst these populations for their health outcomes.
● US Household Food Security Model measured (over 12 months):
○ adequacy of food budget; the quantity of the food they can afford; if the food they
can afford was sufficient to last until they had money to purchase more; and the
nutritional quality of food purchased.
Study Limitations

● Low response rates in this study limit generalizability.

● The results are not generalizable to the US population since CHIS only samples the
California population.

● Due to sample size restrictions, they were not able to include Asian
Americans/Pacific Islanders or Native Americans in their analysis.

● These data do not provide a holistic portrait of health in these varied communities.
Study Implications

● The majority of the literature has not examined the relationship between
food security status and T2D for specific racial-sex subpopulations.
Investigations into food insufficiency in Native populations is needed.

● Further research is needed to identify additional upstream social,

environmental, and economic factors that may contribute to rates of type
2 diabetes for African Americans as well as Latino men.
Discussion
● What stood out? I found it interesting that
the strongest association between food
insecurity and diabetes was among Latina
women.
● “Food insecurity (FI) was significantly
correlated with risk of diabetes (T2D) for
Latinas and White women and men in the
sample, but not Latino men or African
American men or women.”
● What did not stand out? I was not at all
surprised that minority women were 2x as
affected by FI and T2D as white women.
Discussion cont...
● Anything new? Men of all races seem to be
much less affected by food insecurity than
women.
● Anything New? Research indicates that BMI
is no longer the most significant indication of
FI associated T2D
● Impact on reareach? Blacks and Latinos
have higher rates of both low and very low
food insecurity with a minimal association to
T2D. What are other implications of FI?
 ● The article discusses the impact/
correlation between being a
minority and dealing with food

How Content insecurity.It addresses social epi

because it assumes that the

Relates to
social distribution of advantages
and disadvantages are reflective
of health and disease. In this
Epidemiology case, minority populations = food
insecurity= T2D.
● Poverty creates social distress!

Conclusion
Testing associations between
F.I. and chronic disease
permits a better understanding
of recognized disparities in
health outcomes and may help
inform population-specific
intervention.
The relationship between food insecurity
and type 2 diabetes may be moderated by
sex and race.
Positive associations between low food
security and type 2 diabetes was found
between white men, women and Latinas.
No associations were found between food
insecurity and T2D amongst Latino men, African
men and women, however there may be present
several distal factors that may modify the effect
of FI on T2D.
Reference
Strings, S., Ranchod, Y. K., Laraia, B., & Nuru-Jeter, A. (2016). Race and sex differences in the
association between food insecurity and type 2 diabetes. Ethnicity & disease, 26(3), 427.