APPLICATIONS OF TRAJECTORY AND TRANSITION MODELING METHODS TO IMPROVE UNDERSTANDING OF FOOD INSECURITY, HEALTH, AND HEALTH CARE USE AMONG LOW-INCOME LATE MIDDLE-AGED AND OLDER ADULTS IN THE UNITED STATES

Background: Food insecurity is a modifiable social condition linked with several barriers to healthy aging. However, little is known about longitudinal relationships between food insecurity and health or how food insecurity trajectories and transitions may vary across older adults with different racial and ethnic identities. Objective: To estimate longitudinal associations between food insecurity and health and to compare food insecurity trajectories and transitions in non-Hispanic (NH) Black, Hispanic, and NH White adults ages 50 and over. Methods: Using data from the 2010-2018 Health and Retirement Study (HRS), this study uses multilevel growth curve models to estimate longitudinal associations between food insecurity and chronic conditions, functional limitations, and health care use in NH Black, Hispanic, and NH White adults ages 50 and over with incomes below 300 percent of the federal poverty level. The study also uses Group-Based Trajectory Modeling (GBTM) to estimate food insecurity trajectories and Multistate Markov (MSM) models to estimate probabilities of becoming, staying, or ceasing to be food insecure. Results: The multilevel growth curve models estimate that food insecurity is associated with higher chronic conditions (Incident Rate Ratio [IRR] = 1.09, 95% Confidence Interval [CI]: 1.07 - 1.12, p < 0.01) and difficulties with Activities of Daily Living (IRR=1.12, 95% CI: 1.05 - 1.20, p < 0.01) in HRS participants. The GBTM identified heterogeneous food insecurity trajectories, with 13 percent of the sample predicted to follow a trajectory of high and repeated probabilities of being food insecure. The MSM models predicted that 11 percent of HRS participants without food insecurity would become food insecure over approximately two years, and 20 percent would become food insecure over eight years. NH Black participants were substantially more likely to experience unfavorable food insecurity trajectories and transitions than NH White participants. Conclusion: Preventing initial and repeated exposure to food insecurity is critical to promoting healthy aging. Policymakers and health systems should invest in social policies and health care delivery strategies that can more reliably address fluctuating and long-term food insecurity risk. In addition, greater alignment of strategies with the experiences of racially and ethnically minoritized older adults is urgently needed.