Unadjusted and adjusted association of food insecurity, SNAP participation and likelihood of uncontrolled HbA1c with sequential introduction of covariates in a sample of adults with diabetes and income <185% of FPL NHANES 2007–2018
| Unadjusted OR (95% CI) | Model 1 aOR (95% CI) | Model 2 aOR (95% CI) | Model 3 aOR (95% CI) | Final model aOR (95% CI) | |
| Food security and food assistance | |||||
| Food insecure (ref: food secure*) | 1.330 (1.000 to 1.768) | 1.374 (1.022 to 1.848 | 1.254 (0.939 to 1.675) | 1.261 (0.940 to 1.691) | 1.181 (0.877 to 1.589) |
| SNAP participation (ref: no participation) | 0.929 (0.721 to 1.196) | 0.864 (0.664 to 1.124) | 0.948 (0.723 to 1.243) | 0.919 (0.685 to 1.232) | 0.873 (0.651 to 1.172) |
| Demographics | |||||
| Gender (ref: male) | 0.854 (0.672 to 1.087) | 0.851 (0.653 to 1.110) | 0.865 (0.665 to 1.124) | ||
| Race/ethnicity (ref: non-Hispanic white) | 0.818 (0.652 to 1.027) | ||||
| Non-Hispanic black | 1.315 (0.887 to 1.950) | 1.328 (0.887 to 1.990) | 1.512 (1.001 to 2.283) | 1.422 (0.913 to 2.216) | |
| Hispanic | 2.250 (1.651 to 3.068) | 1.987 (1.362 to 2.898) | 2.194 (1.469 to 3.278) | 2.068 (1.337 to 3.199) | |
| Another race or ethnicity or multiple races | 1.970 (1.254 to 3.095) | 1.764 (1.106 to 2.812) | 2.033 (1.247 to 3.314) | 1.946 (1.177 to 3.220) | |
| Widowed, divorced, separated, or never married (ref: married/living with partner) | 0.791 (0.607 to 1.031) | 0.910 (0.677 to 1.222) | 0.974 (0.722 to 1.315) | 1.016 (0.743 to 1.389) | |
| English not usually spoken at home (ref: English usually spoken at home) | 1.823 (1.400 to 2.374) | 1.115 (0.778 to 1.596) | 1.103 (0.754 to 1.614) | 0.983 (0.671 to 1.441) | |
| Comorbidities and diabetes management strategies | |||||
| High blood pressure (ref: no high blood pressure) | 0.640 (0.467 to 0.877) | 0.597 (0.432 to 0.824) | 0.679 (0.491 to 0.939) | ||
| Management strategy (ref: diet controlled) | |||||
| Oral or injectable, no insulin | 1.457 (1.091 to 1.945) | 1.782 (1.315 to 2.417) | 2.265 (1.606 to 3.196) | ||
| Insulin | 2.829 (1.988 to 4.025) | 4.076 (2.798 to 5.937) | 5.383 (3.554 to 8.154) | ||
| Unrestricted carbohydrate intake† (ref: restricted intake) | 1.110 (0.867 to 1.421) | 1.082 (0.829 to 1.414) | 1.051 (0.802 to 1.377) | ||
| Inadequate physical activity (ref: >150 min/week) | 0.686 (0.508 to 0.927) | 0.731 (0.527 to 1.013) | 0.819 (0.582 to 1.154) | ||
| Healthcare utilization | |||||
| Health insurance (ref: private) | |||||
| Medicaid | 1.162 (0.821 to 1.645) | 1.117 (0.787 to 1.585) | |||
| Medicare | 0.796 (0.507 to 1.251) | 0.754 (0.470 to 1.210) | |||
| Other government | 1.280 (0.678 to 2.418) | 1.230 (0.649 to 2.332) | |||
| Self-pay/no insurance | 2.468 (1.656 to 3.679) | 2.199 (1.456 to 3.322) | |||
| Received healthcare in past year (ref: average utilization, 2–9 visits) | |||||
| Low utilization (0–1 visit) | 1.479 (1.061 to 2.064) | 1.495 (1.023 to 2.186) | |||
| High utilization (10+ visits) | 0.783 (0.561 to 1.092) | 0.881 (0.606 to 1.281) | |||
| AIC | 10,978,616 | 10,733,355 | 10,186,035 | 9,840,834.0 | |
Bold text indicates significance at p<0.05.
*Full and marginal food security on USDA 10-item food security module.
†Unrestricted carbohydrate intake was defined as >180 g/day.
FPL, federal poverty level; NHANES, National Health and Nutrition Examination Survey.