Abstract P3170: Identifying moderate to severe food insecurity among hypertensive patients in a low and middle-income Caribbean country

Abstract

Introduction: The Caribbean is experiencing a high burden from food insecurity (FI) and cardiovascular disorders including hypertension. Hypertensive patients with FI need to be easily identified to address social and dietary factors that may worsen blood pressure control and result in adverse health outcomes. In this study we evaluated the ability of single questions from the Latin American and Caribbean Food Security Scale (ELCSA) to identify patients with moderate to severe FI. Hypothesis: We hypothesized that a single question from the ELCSA could be used to screen for moderate to severe FI in adults during a routine clinical encounter Methods: The Addressing Blood Pressure Control using Dietary Approaches (ABCD) study was a cross-sectional study of hypertensive outpatients from a semi-private hospital referral specialist clinic and a government-run primary care facility in Jamaica. The ELCSA scale (excluding questions about children/adolescents) was administered by trained interviewers to all participants. Those with a score of 0 were categorized as food secure, 1-3 mild FI, and ≥ 4 as moderate to severe FI. We calculated the sensitivity, specificity, and positive predictive value of each ELCSA question to evaluate its ability to identify patients with moderate to severe FI. Results: Of the 257 patients interviewed (28% male, 50% over 65 years), 35% had moderate to severe FI. The three questions that best identified these patients were asking whether (i) they or any adult in the home ate less food than what was needed because there was not enough food (sensitivity 79%, specificity 88%), (ii) if the home ran out of food at any time (sensitivity 80%, specificity 87%), and (iii) if they were worried about running out of food (sensitivity 75%, specificity – 88%). All three questions had a positive predictive value over 78%. Conclusion: The inclusion of a single item on food availability during clinical encounters could identify most patients with moderate to severe FI and provides a practical approach to FI screening for Jamaican clinicians. Caribbean clinicians should be encouraged to screen for FI to address this important social determinant of health.