Food Insecurity Among Patients with Chronic Pain in an Urban Slum of Delhi: A Community-Based Cross-Sectional Study.

Background

Food insecurity, defined as a lack of consistent access to sufficient, safe, and nutritious food, is an important social determinant of health. However, its relationship with chronic pain remains poorly understood, particularly in low-and middle-income (LMIC) countries. This study aims to estimate the prevalence of food insecurity and identify its associated factors among patients with chronic pain in an urban slum of Delhi, India.

Methods

A community-based cross-sectional study was conducted in the urban field practice area of Gokalpuri, North-East Delhi. A total of 151 adults aged ≥18 years with chronic pain persisting for more than three months were selected through simple random sampling from a household register. Food insecurity was assessed using the validated Food Insecurity Experience Scale (FIES). Sociodemographic, clinical, economic, psychological and nutritional characteristics were assessed using a semi-structured questionnaire. A priori selected variables were entered simultaneously into a multivariable logistic regression model.

Results

The mean age of participants was 53.0 years, and 74.2% were women. Overall, 41.1% of participants were food insecure, including 16.6% with mild, 8.0% with moderate, and 16.6% with severe food insecurity. Dietary diversity was inadequate among 86.8% of participants which worsened with increasing food insecurity severity (p = 0.005). In the multivariable logistic regression analysis, cost-related care-seeking delay (OR = 10.10, 95% CI: 2.80-36.47, p < 0.001) was independently associated with higher odds of food insecurity, while adequately controlled pain (OR = 0.35, 95% CI: 0.16-0.77, p = 0.009) was independently associated with lower odds. Food-insecure participants also reported significantly poorer wellbeing than food-secure participants (37.1% vs. 60.7% adequate wellbeing, respectively; χ2 = 8.13, p = 0.004).

Conclusions

Food insecurity affected two in five individuals with chronic pain. Cost-related delays in care-seeking were associated with increased odds of food insecurity, whereas adequate pain control was associated with reduced odds. Food-insecure participants also reported poorer wellbeing. Nutritional vulnerability in this population warrants greater attention as part of a comprehensive approach to chronic pain management.