Food insecurity as a predictor of all-cause mortality and premature mortality among older adults: a longitudinal cohort analysis of ELSA study

BACKGROUND: Food insecurity is a growing public health concern, particularly among older adults, as it has been linked to adverse health outcomes, including chronic diseases, sarcopenia and functional decline. However, its direct association with all-cause and premature mortality remains underexplored. AIMS: This study aims to evaluate the relationship between food insecurity and mortality among individuals aged 50 years and older using data from the English Longitudinal Study of Ageing (ELSA). METHODS: A longitudinal analysis was conducted using data from ELSA wave 2 (2004-2005), including 8,686 participants aged ≥ 50 years with available information on food insecurity. Food insecurity was assessed through a single-item self-reported measure. All-cause and early mortality were determined using linked mortality records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for key sociodemographic, lifestyle, and health-related confounders. RESULTS: During the follow-up period, food insecurity was significantly associated with a 41% higher risk of all-cause mortality (HR = 1.41, 95% CI: 1.04-2.82, p = 0.035) after full adjustment for confounders. Additionally, food insecurity was linked to a 126% increased risk of premature mortality (HR = 2.26, 95% CI: 1.26-4.02, p = 0.006). DISCUSSION: Findings suggest that addressing food insecurity could represent a novel strategy to prevent sarcopenia and related mortality in older adults. CONCLUSIONS: Given its significant public health implications, targeted interventions are essential to reduce food insecurity and its associated health burden, ultimately improving longevity and quality of life among aging populations.