Eliminating Food Insecurity in the USA: a Target Trial Emulation Using Observational Data to Estimate Effects on Health-Related Quality of Life.
Eliminating Food Insecurity in the USA: a Target Trial Emulation Using Observational Data to Estimate Effects on Health-Related Quality of Life.
复制标题
消除美国的粮食不安全：使用观察数据估计对健康相关生活质量的影响的目标试验模拟。
DOI：
10.1007/s11606-023-08095-6
复制
发表时间：
2023
影响因子：
5.7
通讯作者：
Hanmer,Janel
中科院分区：
文献类型：
--
作者：
Berkowitz,SethA;Basu,Sanjay;Hanmer,Janel
背景粮食不安全与健康状况不佳的许多方面有关。然而，粮食不安全干预措施的试验通常侧重于资助者感兴趣的结果，例如医疗保健使用、成本或临床表现指标，而不是经历粮食不安全的个人可能优先考虑的生活质量结果。目的模拟消除粮食不安全干预措施的试验，并量化其对健康效用、与健康相关的生活质量和心理健康的估计影响。DesignTarget试验模拟使用来自美国的纵向、全国代表性数据， 2016 年至 2017 年。参与者 医疗支出小组调查中共有 2013 名成年人筛查出粮食不安全呈阳性，代表 3200 万人。主要措施使用成人粮食安全调查模块评估粮食不安全。主要结果是健康效用的 SF-6D（简式六维）衡量标准。次要结果是退伍军人兰德 12 项健康调查（与健康相关的生活质量的衡量标准）的精神成分评分 (MCS) 和身体成分评分 (PCS)、Kessler 6 (K6) 心理困扰和患者健康问卷 2 项 (PHQ2) 抑郁症状。 主要结果 我们估计，消除粮食不安全将提高每 10 万人年 80 QALY 的健康效用，或相对于现状，每人每年 0.008 QALY（95% CI 0.002 至 0.014，p= 0.005）。我们还估计，消除粮食不安全将改善心理健康（MCS 差异[95% CI]：0.55 [0.14 至 0.96]）、身体健康（PCS 差异：0.44 [0.06 至 0.82]）、心理困扰（K6 差异： −0.30 [−0.51 至 −0.09]）和抑郁症状（PCS 差异： −0.30 [−0.51 至 −0.09]）和抑郁症状（PCS 差异： PHQ-2： −0.13 [−0.20 至 −0.07]）。结论消除粮食不安全可能会改善健康的重要但尚未得到充分研究的方面。对粮食不安全干预措施的评估应全面调查其改善健康许多不同方面的潜力。
BackgroundFood insecurity is associated with many aspects of poor health. However, trials of food insecurity interventions typically focus on outcomes of interest to funders, such as healthcare use, cost, or clinical performance metrics, rather than quality of life outcomes that may be prioritized by individuals who experience food insecurity.ObjectiveTo emulate a trial of a food insecurity elimination intervention, and quantify its estimated effects on health utility, health-related quality of life, and mental health.DesignTarget trial emulation using longitudinal, nationally representative data, from the USA, 2016–2017.ParticipantsA total of 2013 adults in the Medical Expenditure Panel Survey screened positive for food insecurity, representing 32 million individuals.Main MeasuresFood insecurity was assessed using the Adult Food Security Survey Module. The primary outcome was the SF-6D (Short-Form Six Dimension) measure of health utility. Secondary outcomes were mental component score (MCS) and physical component score (PCS) of the Veterans RAND 12-Item Health Survey (a measure of health-related quality of life), Kessler 6 (K6) psychological distress, and Patient Health Questionnaire 2-item (PHQ2) depressive symptoms.Key ResultsWe estimated that food insecurity elimination would improve health utility by 80 QALYs per 100,000 person-years, or 0.008 QALYs per person per year (95% CI 0.002 to 0.014,p= 0.005), relative to the status quo. We also estimated that food insecurity elimination would improve mental health (difference in MCS [95% CI]: 0.55 [0.14 to 0.96]), physical health (difference in PCS: 0.44 [0.06 to 0.82]), psychological distress (difference in K6: −0.30 [−0.51 to −0.09]), and depressive symptoms (difference in PHQ-2: −0.13 [−0.20 to −0.07]).ConclusionsFood insecurity elimination may improve important, but understudied, aspects of health. Evaluations of food insecurity interventions should holistically investigate their potential to improve many different aspects of health.