Prevalence and Impact of Food Insecurity in Patients Undergoing Pulmonary Function Testing: A Cross-Sectional Study
Dustin L Norton1, Lauren Witek2, Corey S Obermiller2
1Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases; Wake Forest University School of Medicine, Winston-Salem, NC.
Background:
Food insecurity (FI), the lack of consistent access to food for a healthy life, affected 13.5% of US households in 2023 and is associated with several chronic diseases. Limited data exist on the relationship between FI and lung health.
Research Question:
In this cross-sectional study of adults presenting for pulmonary function testing (PFT), is FI associated with pulmonary function or respiratory symptom burden?
Study Design And Methods:
We conducted a cross-sectional study of adults presenting for PFT between March 2018 and January 2023 in a large academic health network in North Carolina. FI was assessed using a validated 2-item questionnaire. Pulmonary function was measured using percent predicted FEV1 and percent predicted FVC. Respiratory symptoms were assessed using the Modified Medical Research Council dyspnea scale and COPD Assessment Test. Multivariable models adjusting for sociodemographic factors and other covariates were used to evaluate associations between FI, pulmonary function, and symptoms.
Results:
Of 10,805 patients screened, 17.8% reported FI. Patients with FI were more likely to be younger, female, non-Hispanic Black or Hispanic, to actively smoke, and to reside in socioeconomically disadvantaged areas. FI was associated with lower percent predicted FEV1 (-2.55%) and percent predicted FVC (-1.04%), and increased odds of moderate to severe dyspnea (OR, 1.97). Among patients with COPD, FI was associated with higher symptom burden (mean COPD Assessment Test score, 23 vs 17) and more frequently reported moderate or severe dyspnea (67.5% vs 51.2%), with similar findings observed in patients with asthma.
Interpretation:
Our findings suggest that FI is associated with worse pulmonary function and higher respiratory symptom burden in patients undergoing PFT, highlighting the importance of addressing FI as a social determinant of respiratory health. Further research is needed to explore mechanisms and potential interventions to mitigate the impact of FI on lung health.
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