Food insecurity and multidimensional healthy aging across 31 countries: pooled longitudinal evidence from four cohorts.

Food insecurity is a social determinant of health, yet population level evidence on its relation to multidimensional healthy aging across countries remains limited. We pooled harmonized data from four longitudinal studies conducted in the United States, England, 28 European countries, and Mexico from 2010 to 2019, including 232,228 adults aged 60 years or older. Food insecurity was measured with cohort specific questionnaires. Healthy aging was operationalized across four domains: absence of major diseases, absence of functional limitations, no cognitive impairment, and good mental health. Within cohort associations were estimated using generalized estimating equations and combined using random effects meta-analysis. Food insecurity prevalence ranged from 0.1 % in Denmark to 31.8 % in Mexico. In meta-analysis, food insecurity was associated with lower odds of healthy aging (odds ratio 0.78, 95 % confidence interval 0.72 to 0.85). It was most consistently related to higher odds of functional limitations (odds ratio 1.29, 95 % confidence interval 1.15 to 1.45) and poor mental health (odds ratio 1.56, 95 % confidence interval 1.35 to 1.80). Regional heterogeneity was evident, with stronger associations for cognitive impairment in Europe and for functional limitations in Mexico. Associations were larger among adults younger than 75 years and among those who were physically inactive. Food insecurity is linked to worse multidimensional healthy aging. Routine screening and mitigation of food insecurity within aging and social protection programs, tailored to health system capacity and vulnerable subgroups, may help sustain healthier aging.