Relationship between social indicators and food insecurity: a systematic review

The relationships between the social indicators (SIs) that determine food insecurity (FI) have not been described yet. This systematic review aims to identify which SIs are associated with FI in Brazilian households and how these relationships are explained.

Methods:

The research protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO - CRD42018106527). Three independent researchers performed the search in the Latin American and Caribbean Health Sciences Literature (LILACS) and National Library of Medicine (PubMed) databases (June/2018). The study included articles that used the Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar - EBIA) to assess FI and that evaluated the association between SIs and FI.

Results:

We included 18 articles in this review. The Kappa concordance index between the researchers was 0.72 (95%CI 0.42 - 1.00). Most articles were cross-sectional and used multivariate regression for the statistical analysis. At least one income-related SI had a significant association with FI, and, in most studies, they presented the highest values of association measures. We organized the authors’ explanation about the relationships between SIs and FI in a conceptual model. The study identified three possible justifications for the association between SIs and FI: direct relationship, relationship mediated by income, or relationship mediated by another SI and income.

Conclusion:

Income assumed a central role in the mediation between several SIs and FI. However, the analysis methods of the studies did not allow us to investigate this mediation. Therefore, improving data analysis to isolate and understand the effect of SIs on FI is still necessary.

Keywords:
Food and nutrition security; Food supply; Social indicators; Review

Studies (n)	Statistical measure	Social indicators associated with food insecurity/food security*	Measure (confidence intervals)*
General HHs. PB.¹⁶16. Cabral MJ, Vieira KA, Sawaya AL, Florêncio TMMT. Perfil socioeconômico, nutricional e de ingestão alimentar de beneficiários do Programa Bolsa Família. Estud Av 2013; 27(78): 71-87. https://doi.org/10.1590/S0103-40142013000200006 https://doi.org/https://doi.org/10.1590/... (406)	χ²/proportion (%)		2005	2011
		Improvement in HH income	39.5%	24.4%
		Continued to participate in a CCTP	61.5%	45.9%
		Stopped participating in a CCTP	41.5%	19.5%
General HHs (data from PNAD). Brazil¹⁷17. Santos TG, Silveira JAC, Longo-Silva G, Ramires EKNM, Menezes RCE. Tendência e fatores associados à insegurança alimentar no Brasil: Pesquisa Nacional por amostra de Domicílios 2004, 2009 e 2013. Cad Saúde Pública 2018; 34(4): e00066917. https://doi.org/10.1590/0102-311x00066917 https://doi.org/https://doi.org/10.1590/... (2004 = 108,377; 2009 = 117,037; 2013 = 110,655)	Log-binomial regression / PR Hierarchical model	Results from the 3^rd level	2013**
		Having major HH goods	2.08 (1.99 - 2.17)
		Head of HH with ≤ 4 years of schooling	1.94 (1.86 - 2.01)
		Living in the North/Northeast regions	1.81 (1.72 - 1.91)
		Non-white head of HH	1.58 (1.52 - 1.65)
		Head of HH aged < 60 years	1.52 (1.46 - 1.59)
		> 2 residents/bedroom	1.45 (1.40 - 1.50)
		Inadequate sanitation	1.41 (1.35 - 1.48)
		Female head of HH	1.32 (1.28 - 1.37)
		Unemployed head of HH	1.26 (1.20 - 1.31)
		Living in a rural area	0.88 (0.83 - 0.93)
HHs with severe food insecurity (data from Census and PNAD). Brazil³²32. Gubert MB, Benício MHDA, Silva JP, Rosa TEC, Santos SM, Santos LMP. Use of a predictive model for food insecurity estimates in Brazil. Arch Latinoam Nutr 2010; 60(2): 119-25. (111,922)	MLR/OR	Per capita income < 1/4 MW^b	11.33 (10.08 - 12.74)
		Head of HH with < 1 year of schooling	4.76 (4.19 - 5.42)
		Living in Roraima	3.16 (2.06 - 4.83)
		Lack of public water supply	1.78 (1.59 - 1.99)
		Female head of HH	1.60 (1.50 - 1.71)
		≥ 3 residents aged < 10 years/HH	1.57 (1.42 - 1.74)
		Black and/or multiracial head of HH	1.49 (1.39 - 1.61)
		No. of residents/HH	0.93 (-)
		Living in a rural area	0.50 (0.44 - 0.58)
HHs covered by ESF. PI²³23. Sabóia RCB, Santos MM. Prevalência de insegurança alimentar e fatores associados em domicílios cobertos pela Estratégia Saúde da Família em Teresina, Piauí, 2012-2013. Epidemiol Serv Saúde 2015; 24(4): 749-58. https://doi.org/10.5123/S1679-49742015000400017 https://doi.org/https://doi.org/10.5123/... (323)	MLR/OR	Participating in a CCTP	4.10 (1.13 - 14.90)
		≤ 5 rooms/HH	3.65 (1.31 - 10.15)
		Per capita income <½ MW^g	3.52 (1.02 - 12.74)
		Unfinished house	0.34 (0.16 - 0.72)
		Female head of HH	0.14 (0.04-0.56)
HHs with children/adolescents attending public school. BA²⁴24. De Souza Bittencourt L, Dos Santos SMC, Pinto EJ, Aliaga MA, Ribeiro-Silva RC. Factors associated with food insecurity in households of public students of Salvador city, Bahia, Brazil. J Health Popul Nutr 2013; 31(4): 471-9. (1,101)	MLR/OR	Per capita income ≤ ¼ MW^d	2.63 (1.68 - 4.08)
General HHs. AL.²⁵25. Ferreira HS, Souza MEDCA, Moura FA, Horta BL. Prevalência e fatores associados à Insegurança Alimentar e Nutricional em famílias dos municípios do norte de alagoas, Brazil, 2010. Ciênc Saúde Coletiva 2014; 19(5): 1533-42. https://doi.org/10.1590/1413-81232014195.06122013 https://doi.org/https://doi.org/10.1590/... (1,444)	MPR/PR	Untreated drinking water	2.64 (1.47 - 4.74)
		Head of HH with ≤ 4 years of schooling	1.63 (1.30 - 2.05)
		≤ 4 rooms/HH	1.38 (1.16 - 1.65)
		Participating in a CCTP	1.33 (1.11 - 1.59)
		≥ 4 residents/HH	1.27 (1.08 - 1.50)
		Female head of HH	1.25 (1.06 - 1.47)
		Maternal schooling ≤ 4 years	1.21 (1.01 - 1.46)
Lower socioeconomic HHs. SP²⁶26. Souza BFNJ, Marin-Leon L, Camargo DFM, Segall-Correa AM. Demographic and socioeconomic conditions associated with food insecurity in households in Campinas, SP, Brazil. Rev Nutr 2016; 29(6): 845-57. https://doi.org/10.1590/1678-98652016000600009 https://doi.org/https://doi.org/10.1590/... (691)	MMLR/OR	Head of HH informally employed	4.51 (1.51 - 13.4)
		Participating in a CCTP	3.33 (1.22 - 9.09)
		Unfinished house	3.20 (1.38 - 7.39)
		Increase by 1 HH good	0.86 (0.80 - 0.92)
HHs participating in CCTP (data from PNAD). Brazil¹⁸18. Segall-Corea AM, Marin-Leon L, Helito H, Perez-Escamilla R, Santos LMP, Paes-Sousa R. Transferência de renda e segurança alimentar no Brasil: análise dos dados nacionais. Rev Nutr 2008; 21(Suppl.): S39-S51. (112,716)	MLR/OR	≥ 1 resident aged < 18 years/HH	1.91 (1.09 - 3.35)
		Male head of HH	1.64 (1.31 - 2.04)
		Head of HH with ≥ 4 years of schooling	1.43 (1.22 - 1.68)
		White head of HH	1.39 (1.16 - 1.64)
		≤ 5 residents/HH	1.36 (1.18 - 1.62)
		≤ 2 residents/room	1.33 (1.18 - 1.49)
		Living in a non-metropolitan area	1.22 (1.07 - 1.40)
		Increase in income by US$ 3.67ª	1.08 (1.04 - 1.12)
Quilombola HHs (data from Census Quilombola). Brazil²⁷27. Gubert MB, Segall-Correa AM, Spaniol AM, Pedroso J, Coelho SEAC, Perez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr 2017; 20(8): 1513-22. https://doi.org/10.1017/s1368980016003414 https://doi.org/https://doi.org/10.1017/... (8,856)	MLR/OR	Living in the North region	11.26 (7.83 - 16.19)
		≥ 8 residents/HH	3.52 (2.90 - 4.26)
		Per capita income < US$ 44^f	2.78 (2.36 - 3.29)
		Head of HH with ≤ 4 years of schooling	1.92 (1.29 - 2.85)
		Lack of public sewer	1.88 (1.61 - 2.19)
		Lack of public water supply	1.23 (1.10 - 1.39)
		Not participating in a CCTP	0.66 (0.58 - 0.75)
HHs with children covered by ESF. NE and S²⁸28. Facchini LA, Nunes BP, Motta JVS, Tomasi E, Silva SM, Thumé E, et al. Insegurança alimentar no Nordeste e Sul do Brasil: magnitude, fatores associados e padrões de renda per capita para redução das inequidades. Cad Saude Pública 2014; 30(1): 161-74. https://doi.org/10.1590/0102-311X00036013 https://doi.org/https://doi.org/10.1590/... (NE = 5,419 / S = 5,081)	MPR/PR	Results from the Northeast region:
		Per capita income ≤ US$ 40.98^e	8.38 (5.87 - 11.96)
		Black mother	1.50 (1.18 - 1.90)
		Maternal schooling ≤ 4 years	1.43 (1.23 - 1.66)
		Female head of HH	1.32 (1.18 - 1.47)
		≥ 3 residents aged < 7 year/HH	1.28 (1.08 - 1.51)
		Participating in a CCTP	1.26 (1.11 - 1.42)
		Results from the South region:
		Per capita income US$ 40.98-61.47^e	8.10 (5.36 - 12.25)
		Maternal schooling ≤ 4 years	1.87 (1.36 - 2.58)
		Participating in a CCTP	1.48 (1.17 - 1.87)
		Female head of HH	1.42 (1.12 - 1.80)
		Multiracial mother	1.37 (1.11 - 1.70)
HHs with children attending public school. PB²⁹29. Pedraza DF, Gama JSFA. Segurança alimentar e nutricional de famílias com crianças menores de cinco anos do município de Campina Grande, Paraíba. Rev Bras Epidemiol 2015; 18(4): 906-17. https://doi.org/10.1590/1980-5497201500040018 https://doi.org/https://doi.org/10.1590/... (793)	MPR/PR	Untreated drinking water	1.65 (1.26 - 2.17)
		Not having a refrigerator	1.54 (1.13 - 2.09)
		≥ 6 residents/HH	1.24 (1.04 - 1.64)
		Lack of toilet in the house	1.21 (1.09 - 1.63)
HHs participating in CCTP with children. MG¹⁹19. Sperandio N, Priore SE. Prevalência de insegurança alimentar domiciliar e fatores associados em famílias com pré-escolares, beneficiárias do Programa Bolsa Família de Viçosa, Minas Gerais, Brasil. Epidemiol Serv Saúde 2015; 24(4): 739-48. https://doi.org/10.5123/S1679-49742015000400016 https://doi.org/https://doi.org/10.5123/... (243)	BPR/PR	Maternal schooling < 7 years	1.86 (1.52 - 2.83)
HHs with children/adolescents. RJ³³33. Salles-Costa R, Pereira R, Vasconcellos MTL, Veiga GV, Marins VMR, Jardim BC, et al. Associação entre fatores socioeconômicos e insegurança alimentar: estudo de base populacional na Região Metropolitana do Rio de Janeiro, Brasil. Rev Nutr 2008; 21 (Suppl. 0): S99-S109. (1,085)	PR/PR	> 8 residents/HH	6.18 (1.31 - 11.06)
Low HH income PB²⁰20. Vianna RPT, Segall-Correa AM. Insegurança alimentar das famílias residentes em municípios do interior do estado da Paraíba, Brasil. Rev Nutr 2008; 21(Suppl.): S111-S22. (4,533)	MLR/OR	Per capita income ≤ US$ 10.64^c	19.10 (11.75 - 31.04)
		Unfinished house	1.98 (1.64 - 2.38)
		Lack of public water supply	1.38 (1.15 - 1.65)
HHs with children (data from PNDS). Brazil³⁰30. Poblacion AP, Cook JT, Marin-Leon L, Segall-Correa AM, Silveira JAC, Konstantyner T, et al. Food insecurity and the negative impact on brazilian children’s health - why does food security matter for our future prosperity? Brazilian National Survey (PNDS 2006/07). Food Nutr Bull 2016; 37(4): 585-98. https://doi.org/10.1177/0379572116664167 https://doi.org/https://doi.org/10.1177/... (3,923)	MPR/PR	Living in the N/NE regions	1.9 (1.7 - 2.2)
		Maternal schooling ≤ 8 years	1.9 (1.5 - 2.3)
		Socioeconomic classification D/E	1.8 (1.6 - 2.1)
HHs with children (data from PNDS). Brazil³⁰30. Poblacion AP, Cook JT, Marin-Leon L, Segall-Correa AM, Silveira JAC, Konstantyner T, et al. Food insecurity and the negative impact on brazilian children’s health - why does food security matter for our future prosperity? Brazilian National Survey (PNDS 2006/07). Food Nutr Bull 2016; 37(4): 585-98. https://doi.org/10.1177/0379572116664167 https://doi.org/https://doi.org/10.1177/... (3,923)	MPR/PR	Participating in a CCTP	1.4 (1.2 - 1.6)
		≥ 3 residents in preschool age/HH	1.4 (1.2 - 1.7)
		House with poor-quality construction materials	1.3 (1.1 - 1.4)
		Female head of HH without a partner	1.3 (1.1 - 1.5)
		Living in a rural area	0.8 (0.7 - 0.9)
		Female head of HH	2.21 (1.47 - 3.31)
		No. of residents/bedroom ≥ 3	1.91 (1.23 - 2.96)
		Living in inadequate conditions	1.84 (1.12 - 2.08)
		Head of HH with ≤ 4 years of schooling	1.68 (1.00 - 2.81)
HHs with adolescents. MT³¹31. Guerra LDS, Espinosa MM, Bezerra ACD, Guimarães LV, Lima-Lopes MA. Insegurança alimentar em domicílios com adolescentes da Amazônia Legal Brasileira: prevalência e fatores associados. Cad Saúde Pública 2013; 29(2): 335-48. https://doi.org/10.1590/S0102-311X2013000200020 https://doi.org/https://doi.org/10.1590/... (363)	MPR/PR	Monthly income ≤½ MW^d	5.60 (2.36 - 13.27)
		Black adolescent	2.37 (1.48 - 3.80)
		Untreated drinking water	2.08 (1.48 - 2.94)
		Head of HH born in the city	1.69 (1.13 - 2.51)
HHs covered by NASF. GO²¹21. Peixoto MRG, Ramos K, Martins KA, Schincaglia RM, Braudes-Silva LA. Insegurança alimentar na área de abrangência do Núcleo de Apoio à Saúde da Família em Itumbiara, Goiás. Epidemiol Serv Saúde 2014; 23(2): 327-36. https://doi.org/10.5123/S1679-49742014000200014 https://doi.org/https://doi.org/10.5123/... (356)	MPR/PR	Socioeconomic classification D/E	2.2 (1.3 - 3.2)
		Unfinished house	1.3 (1.0 - 1.5)
		Not participating in a CCTP	1.3 (1.1 - 1.6)
		≥ 5 residents/HH	1.3 (1.1 - 1.6)
General HHs BA.²²22. Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Insegurança alimentar em comunidades rurais no Nordeste brasileiro: faz diferença ser quilombola? Cad Saúde Pública 2017; 33(4): e00005716. https://doi.org/10.1590/0102-311x00005716 https://doi.org/https://doi.org/10.1590/... (459)	MPR/PR	Socioeconomic classification E	3.22 (1.95 - 5.32)
		Participating in a CCTP	1.52 (1.25 - 1.84)
		Being a quilombola	1.25 (1.06 - 1.47)
		≥ 4 residents/HH	1.20 (1.01 - 1.43)

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[1] Corresponding author: Juliana de Bem Lignani. Universidade Federal do Rio de Janeiro Ringgold Standard Institution, Instituto de Nutrição Josué de Castro, Ilha do Fundão, Centro de Ciências da Saúde. Bloco J, 2º andar, CEP: 21941-901, Rio de Janeiro, RJ, Brazil. E-mail: julianablig@gmail.com