Table 3.
Unadjusted and adjusted association of food insecurity, SNAP participation and likelihood of uncontrolled HbA1c with sequential introduction of covariates in a sample of adults with diabetes and income <185% of FPL NHANES 2007–2018
| Unadjusted OR (95% CI) |
Model 1 aOR (95% CI) |
Model 2 aOR (95% CI) |
Model 3 aOR (95% CI) |
Final model aOR (95% CI) |
|
| Food security and food assistance | |||||
| Food insecure (ref: food secure*) |
1.330 (1.000 to 1.768) |
1.374
(1.022 to 1.848 |
1.254 (0.939 to 1.675) |
1.261 (0.940 to 1.691) |
1.181 (0.877 to 1.589) |
| SNAP participation (ref: no participation) |
0.929 (0.721 to 1.196) |
0.864 (0.664 to 1.124) |
0.948 (0.723 to 1.243) |
0.919 (0.685 to 1.232) |
0.873 (0.651 to 1.172) |
| Demographics | |||||
| Gender (ref: male) |
0.854 (0.672 to 1.087) |
0.851 (0.653 to 1.110) |
0.865 (0.665 to 1.124) |
||
| Race/ethnicity (ref: non-Hispanic white) |
0.818 (0.652 to 1.027) |
||||
| Non-Hispanic black | 1.315 (0.887 to 1.950) |
1.328 (0.887 to 1.990) |
1.512 (1.001 to 2.283) |
1.422 (0.913 to 2.216) |
|
| Hispanic |
2.250 (1.651 to 3.068) |
1.987 (1.362 to 2.898) |
2.194 (1.469 to 3.278) |
2.068 (1.337 to 3.199) |
|
| Another race or ethnicity or multiple races |
1.970 (1.254 to 3.095) |
1.764 (1.106 to 2.812) |
2.033 (1.247 to 3.314) |
1.946 (1.177 to 3.220) |
|
| Widowed, divorced, separated, or never married (ref: married/living with partner) | 0.791 (0.607 to 1.031) |
0.910 (0.677 to 1.222) |
0.974 (0.722 to 1.315) |
1.016 (0.743 to 1.389) |
|
| English not usually spoken at home (ref: English usually spoken at home) |
1.823 (1.400 to 2.374) |
1.115 (0.778 to 1.596) |
1.103 (0.754 to 1.614) |
0.983 (0.671 to 1.441) |
|
| Comorbidities and diabetes management strategies | |||||
| High blood pressure (ref: no high blood pressure) |
0.640 (0.467 to 0.877) |
0.597 (0.432 to 0.824) |
0.679 (0.491 to 0.939) |
||
| Management strategy (ref: diet controlled) |
|||||
| Oral or injectable, no insulin |
1.457 (1.091 to 1.945) |
1.782 (1.315 to 2.417) |
2.265 (1.606 to 3.196) |
||
| Insulin |
2.829 (1.988 to 4.025) |
4.076 (2.798 to 5.937) |
5.383 (3.554 to 8.154) |
||
| Unrestricted carbohydrate intake† (ref: restricted intake) |
1.110 (0.867 to 1.421) |
1.082 (0.829 to 1.414) |
1.051 (0.802 to 1.377) |
||
| Inadequate physical activity (ref: >150 min/week) |
0.686 (0.508 to 0.927) |
0.731 (0.527 to 1.013) |
0.819 (0.582 to 1.154) |
||
| Healthcare utilization | |||||
| Health insurance (ref: private) |
|||||
| Medicaid | 1.162 (0.821 to 1.645) |
1.117 (0.787 to 1.585) |
|||
| Medicare | 0.796 (0.507 to 1.251) |
0.754 (0.470 to 1.210) |
|||
| Other government | 1.280 (0.678 to 2.418) |
1.230 (0.649 to 2.332) |
|||
| Self-pay/no insurance |
2.468 (1.656 to 3.679) |
2.199 (1.456 to 3.322) |
|||
| Received healthcare in past year (ref: average utilization, 2–9 visits) |
|||||
| Low utilization (0–1 visit) |
1.479 (1.061 to 2.064) |
1.495 (1.023 to 2.186) |
|||
| High utilization (10+ visits) | 0.783 (0.561 to 1.092) |
0.881 (0.606 to 1.281) |
|||
| AIC | 10,978,616 | 10,733,355 | 10,186,035 | 9,840,834.0 | |
Bold text indicates significance at p<0.05.
*Full and marginal food security on USDA 10-item food security module.
†Unrestricted carbohydrate intake was defined as >180 g/day.
FPL, federal poverty level; NHANES, National Health and Nutrition Examination Survey.