Food insecurity and frailty among women with and without HIV in the United States: a cross-sectional analysis

• Type of Material: Article
• Authors: Judy Y. Tan, University of California San Francisco; Lila A. Sheira, University of California San Francisco; Edward A. Frongillo, University of South Carolina; Deborah Gustafson, SUNY Downstate Health Sciences University; Anjali Sharma, Albert Einstein College of Medicine; Daniel Merenstein, Georgetown University; Mardge H. Cohen, Stroger Hospital of Cook County; Elizabeth Golub, Johns Hopkins University; Andrew Edmonds, University of North Carolina; Ighovwerha Ofotokun, Emory University; Margaret Fischl, University of Miami; Deborah Konkle-Parker, University of Mississippi; Torsten Neilands, University of California San Francisco; Phillis Tien, University of California San Francisco; Sheri D. Weiser, University of California San Francisco
• Language: English
• Date: 2021-06-01
• Publisher: JOHN WILEY & SONS LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/jia2.25751
• Title of Journal or Parent Work: JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
• Volume: 24
• Issue: 6
• Start Page: e25751
• End Page: e25751
• Grant/Funding Information: The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). This study was funded by a Women’s Interagency HIV Study sub‐study grant from the National Institute of Mental Health, K24AI134326 (Weiser) and MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth and Gina Wingood), U01‐HL146241; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01‐HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01‐HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01‐HL146193; Chicago‐Cook County CRS (Mardge Cohen and Audrey French), U01‐HL146245; Northern California CRS (Bradley Aouizerat, Jennifer Price and Phyllis Tien), U01‐HL146242; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01‐HL146205; Miami CRS (Maria Alcaide, Margaret Fischl and Deborah Jones), U01‐HL146203; UAB‐MS CRS (Mirjam‐Colette Kempf, Jodie Dionne‐Odom and Deborah Konkle‐Parker), U01‐HL146192; UNC CRS (Adaora Adimora), U01‐HL146194. The MWCCS is funded primarily by the National Heart, Lung and Blood Institute (NHLBI), with additional co‐funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD) and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1‐TR000004 (UCSF CTSA), P30‐AI‐050409 (Atlanta CFAR), P30‐AI‐050410 (UNC CFAR) and P30‐AI‐027767 (UAB CFAR).
• Keywords: Infectious Diseases; Food insecurity; Immunology; Life Sciences & Biomedicine; frailty; NUTRITIONAL-STATUS; DISEASE; PREVALENCE; OLDER-ADULTS; INTERAGENCY HIV; Science & Technology; UNINFECTED WOMEN; HIV; INFECTION; MEN; women; PHENOTYPE; RISK
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Immunology

Abstract

Introduction: Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who may be particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. Methods: There were 1265 participants from the Women’s Interagency HIV Study who participated in frailty assessments in 2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre-frail or frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross-sectional associations between food insecurity and frailty while adjusting for socio-demographic, behavioural and HIV status covariates. Results and discussion: Approximately one-third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre-frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37 (95% CI [1.38 to 8.24], p < 0.01); the corresponding RRR of pre-frailty was 3.63 (95% CI [1.76 to 7.51], p < 0.001). Higher annual household income was associated with lower RRRs of frailty or pre-frailty (p < 0.01). Similarly, older age was associated with more frequent frailty (RRR=1.06, 95% CI [1.03 to 1.09], p < 0.001). HIV serostatus was not significantly associated with either pre-frailty (RRR=0.97, 95% CI [0.71 to 1.31]) or frailty (RRR=0.75, 95% CI [0.48 to 1.16]). Conclusions: Very low food security was associated with more frequent frailty and pre-frailty among women with and without for HIV. HIV serostatus was not associated with frailty.