Food insecurity and hypertension prevalence, awareness, and control in the Eastern Caribbean Health Outcomes Research Network Study

Limited evidence exists on the association between food insecurity (FI) and the hypertension care cascade 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. 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 secure, mild, moderate, and severe. Hypertension was defined using guidelines from the Seventh Report of the Joint National Committee on Prevention and Caribbean Health Research Council. Poisson regression was used to estimate prevalence ratios for the association between FI and hypertension prevalence, awareness, and control, adjusting for covariates. Overall prevalence of FI was 28 percent in our sample. Seventeen percent experienced mild, 6 percent moderate, and 4 percent experienced severe FI. Fifty-eight percent had hypertension, 65 percent were aware of their hypertension, and among those aware, 56 percent had uncontrolled hypertension. Model results showed no association between FI and hypertension prevalence and awareness. Results for control showed moderate FI (PR = 1.33, CI = 1.09-1.64) and severe FI (PR = 1.30, CI = 1.05-1.62) were associated with 30 percent higher prevalence of uncontrolled hypertension compared to those who are food secure. Sex-stratified results showed women with moderate (PR = 1.39, CI = 1.13-1.71) and severe FI (PR = 1.41, CI = 1.16-1.72) had 40 and 41 percent higher prevalence of uncontrolled hypertension compared to food secure women, respectively. Results for men were not statistically significant. Findings align with prior evidence of greater FI prevalence among women and associations with hypertension control. Nutrition policies are needed to reduce FI prevalence and increase access to affordable, nutritious foods. Results warrant further studies to understand sex differences in FI prevalence and the impact on hypertension.