Association between food insecurity and five cardiometabolic conditions in a national network of federally qualified health centers

Food insecurity is associated with cardiometabolic conditions, and few studies have occurred in U.S. federally qualified health centers (FQHCs), which serve vulnerable populations. This study examined the association of food insecurity with five cardiometabolic conditions among FQHC patients and whether associations differed by sex. This cross-sectional analysis used electronic health record (EHR) data from adults who completed a 2-item food insecurity screener in 419 FQHC clinic sites throughout 20 U.S. states, 2017–2021. Food insecurity was defined by a positive response to either screening question during the study period. Outcomes were obesity, dyslipidemia, hypertension, prediabetes or diabetes (hereafter “dysglycemia”), and cardiovascular disease (CVD). Data were analyzed 2023–2024. Among 182,499 adults, 18,401 (10.1%) screened positive for food insecurity. Those with food insecurity were older (43.8 vs. 40.3 years), with a higher proportion reporting Black race (45.6% vs. 37.2%) and Medicaid insurance (27.4% vs. 22.3%). Food insecurity was associated with hypertension (adjusted odds ratio [aOR] 1.11; 95% CI 1.07, 1.16), dysglycemia (aOR 1.08; 95% CI 1.04, 1.12), and CVD (aOR 1.18; 95% CI 1.08, 1.28), but not obesity or dyslipidemia. Among females, food insecurity was significantly associated with all cardiometabolic conditions. In a national sample of FQHC patients, food insecurity was associated with increased risk of hypertension, dysglycemia, and CVD, which were driven largely by stronger associations among female patients. While FQHCs provide services that address food insecurity, additional strategies may be needed to reduce the burden of food insecurity on women’s cardiometabolic health in this setting.