Food insecurity is associated with poor hypertension management in the Eastern Caribbean

Background  Limited evidence exists on the association between food insecurity (FI) and blood pressure control in the Caribbean despite the high burden of both. The objective of this study is to examine the relationship between FI and hypertension prevalence, awareness, and control in the Eastern Caribbean.    Methods and Findings  We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (n=2961). Food insecurity was measured using the Latin American and Caribbean Food Security Scale (ELCSA) and classified as 0=no FI, 1-6 mild/moderate FI, and 7-9 severe FI. Hypertension was defined by the Seventh Report of the Joint National Committee on Prevention. Logistic regression modeling was conducted to examine the relationship between FI and hypertension prevalence, awareness, and control, adjusting for age, sex, educational attainment, site, and usual source of care.   Prevalence of FI was 28 percent among participants and was higher in Puerto Rico and Trinidad and Tobago compared to other sites. Seventeen percent of the participants experienced low, 6 percent moderate, and 4 percent experienced severe FI. Aggregate model results showed no association between FI and hypertension outcomes. Sex-stratified results showed moderate (OR=2.65, CI=1.25-5.65) and severe FI (OR=3.69, CI=1.20-11.31) were positively associated with lack of control among women.   Limitations of this study include the cross-sectional design, small sample size, and the average age of our cohort. Cross-sectional design precluded the ability to make inferences about temporality between FI and HTN prevalence and awareness. Small sample size precluded the ability to detect statistically significant differences despite strong odds ratios for model results like lack of control.   Conclusions  Findings align with prior evidence of greater FI prevalence among women and negative health impact. Nutrition policies are needed to reduce the overall FI burden in the Caribbean and increase access to affordable, nutritious foods. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement The study sponsor has no role in the study design, collection, analysis, and interpretation of the data. To the best of our knowledge, there are no relevant conflicts of interest, financial or otherwise, relevant to this study and the publication thereof to declare. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ECS study was approved by the Yale University Human Subjects Investigation Committee, the Institutional Review Boards of the University of Puerto Rico Medical Sciences Campus, the University of the Virgin Islands, and the University of the West Indies Cave Hill Campus, as well as by the Ministry of Health of Trinidad and Tobago. The current analysis was approved by the Data Access and Scientific Review Committee of the ECS. This study was reported according to STROBE guidelines. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The corresponding author had full access to all the data in the study and takes responsibility for its integrity and the data analysis. Data described in the manuscript will be made available upon reasonable request.