Food Insecurity Is Associated with Increased Risk of Ischemic Stroke.

Abstract

Food insecurity has been linked to adverse health outcomes, but its relationship with ischemic stroke in older adults remains unclear. This study examined the association between food insecurity and ischemic stroke incidence among adults aged 65 years and older. This cohort study used data from the 2005-2006 National Health and Nutrition Survey of Israeli community-dwelling older adults, linked to the Israeli National Stroke Registry (2014-2022). Data were analyzed in 2025. Food insecurity was assessed using the 6-item United States Department of Agriculture household food security scale. First-recorded ischemic stroke events during follow-up, whether first-ever or recurrent, were included. Multivariable Fine and Gray proportional hazard models, accounting for death as a competing risk, estimated subdistribution hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke by food security status: food insecure (low and very low food secure) vs. high food secure. The dataset included 1,337 participants (median age: 73 years, 57.4% women) who were alive on January 1, 2014, the start of the study follow-up. Over a mean follow-up period of 6.6±3.0 years (through the end of 2022), 82 ischemic stroke events were documented. After multivariable adjustment, food insecurity was associated with an increased risk of first-recorded ischemic stroke (HR=2.02; 95% CI: 1.12-3.65). When analyses were restricted to first-ever ischemic stroke events, the association was stronger (HR=2.65; 95% CI: 1.33-5.29). Food insecurity was associated with a higher risk of ischemic stroke among older adults. Addressing food insecurity may support stroke prevention in older populations.