Association between Food Insecurity and Chronic Eye Disease in the National Institutes of Health's All of Us Research Program

Purpose Food insecurity is a potential risk factor for visual impairment; however, its association with specific eye diseases remains unknown. This study aims to examine the association between food insecurity and chronic eye diseases including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts. Design Cross-sectional. Participants Participants of the All of Us (AoU) Research Program, who had electronic health record data and responded to survey questions regarding food insecurity. Methods Population-based. Multivariable logistic regression was used to examine associations between food insecurity and each eye disease. Main Outcome Measure(s) Primary outcomes included glaucoma, AMD, DR, or cataracts, based on the International Classification of Disease, 9th and 10th Revision codes. Results A total of 78 694 participants were included in the study population. Of these, 9732 (12.4%) reported food insecurity, 2095 (2.7%) had glaucoma, 1398 (1.8%) had AMD, 1127 (1.4%) had DR, and 10 135 (12.9%) had cataracts. Compared with those without food insecurity, participants with food insecurity had significantly higher odds of glaucoma (adjusted odds ratio [aOR]: 1.43, 95% confidence interval [CI]: 1.18–1.72, P ≤ 0.001) but not of AMD (aOR: 0.91, 95% CI: 0.67–1.21, P = 0.544), DR (aOR: 1.15, 95% CI: 0.93–1.42, P = 0.180), or cataracts (aOR: 0.97, 95% CI: 0.87–1.08, P = 0.635). Conclusions This study found a positive association between food insecurity and glaucoma in the AoU Research Program. Further research should focus on understanding disease-specific mechanisms for this association. Adequate social determinants of health screening and population interventions to improve stable access to healthy food options may prove vital for reducing the risk of eye disease. Financial Disclosure(s) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.