Sociodemographic Determinants of Food Insecurity and Its Association With BMI in Individuals With Spinal Cord Injury: A Cross-sectional Analysis From the All of Us Research Program.

OBJECTIVE

To compare the prevalence of food insecurity (FI) in adults with spinal cord injury (SCI) versus a matched control cohort without self-reported disability, identify demographic and socioeconomic correlates of FI, and examine the association between FI and body mass index (BMI).

DESIGN

Cross-sectional analysis.

SETTING

U.S. nationwide cohort from the All of Us Research Program.

PARTICIPANTS

A cohort of 751 adults with SCI and a 1:3 age-, sex-, race-, and ethnicity-matched control cohort.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE(S): FI and BMI.

RESULTS

Overall, 19.0% of participants with SCI (n=143) experienced FI, which was higher than the prevalence observed in the control cohort (15.6%; P<.05). In univariate analyses, risks of FI were elevated among participants who were Black or Hispanic, women, younger, unmarried, unemployed, had lower educational attainment, and had lower income (all P<.05). In multivariable logistic regression, higher income, being retired, and education beyond high school were associated with lower odds of FI, whereas race, ethnicity, sex, and marital status were no longer significant. In BMI analyses, FI was associated with higher BMI in unadjusted models, but this association was attenuated after covariate adjustment. Exploratory analyses suggested effect modification by race: among White participants, FI was associated with higher BMI (+1.73 kg/m²; P<.05), whereas among Black participants, FI was associated with lower BMI (-3.22 kg/m²; Pinteraction=.02). Sensitivity analyses using BMI ≥25 or ≥30 kg/m² yielded consistent racial-specific patterns.

CONCLUSIONS

These findings highlight FI as an important social determinant of health in SCI, shaped largely by socioeconomic conditions rather than demographic and injury characteristics. The association between FI and weight status in SCI may differ across racial groups, warranting further investigation into the pathways through which material hardship influences health in this population.