Food insecurity is associated with poor hypertension management in the Eastern Caribbean

ABSTRACT Background Limited evidence exists on the association between food insecurity (FI) and blood pressure control in the Caribbean despite the high burden of both. The objective of this study is to examine the relationship between FI and hypertension prevalence, awareness, and control in the Eastern Caribbean. Methods and Findings We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (n=2961). Food insecurity was measured using the Latin American and Caribbean Food Security Scale (ELCSA) and classified as 0=no FI, 1-6 mild/moderate FI, and 7-9 severe FI. Hypertension was defined by the Seventh Report of the Joint National Committee on Prevention. Logistic regression modeling was conducted to examine the relationship between FI and hypertension prevalence, awareness, and control, adjusting for age, sex, educational attainment, site, and usual source of care. Prevalence of FI was 28 percent among participants and was higher in Puerto Rico and Trinidad and Tobago compared to other sites. Seventeen percent of the participants experienced low, 6 percent moderate, and 4 percent experienced severe FI. Aggregate model results showed no association between FI and hypertension outcomes. Sex-stratified results showed moderate (OR=2.65, CI=1.25-5.65) and severe FI (OR=3.69, CI=1.20-11.31) were positively associated with lack of control among women. Limitations of this study include the cross-sectional design, small sample size, and the average age of our cohort. Cross-sectional design precluded the ability to make inferences about temporality between FI and HTN prevalence and awareness. Small sample size precluded the ability to detect statistically significant differences despite strong odds ratios for model results like lack of control. Conclusions Findings align with prior evidence of greater FI prevalence among women and negative health impact. Nutrition policies are needed to reduce the overall FI burden in the Caribbean and increase access to affordable, nutritious foods.