The Association of Food Insecurity and Risk of Mortality: A Systematic Review and Meta-Analysis of Large-Scale Cohorts.

Objectives: Food insecurity (FI) represents a significant global public health issue, yet existing literature presents inconsistent findings regarding its association with mortality risk. This systematic review and meta-analysis aimed to synthesize available evidence to evaluate the relationship between FI and mortality. Setting: A systematic search was conducted using the ISI Web of Science, PubMed/MEDLINE, and Embase databases without any date limitation until February 18, 2025. Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using a random-effects model, while validated methods examined quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests, respectively. Results: Findings from 19 studies demonstrated a significant association between FI and increased risk of mortality (HR = 1.23; 95% CI: 1.16, 1.30; I² = 83.1%; p < 0.001; n = 19). Subgroup analyses indicated a dose-response relationship, with mortality risk increasing by FI severity: mild (HR = 1.16; 95% CI: 1.10, 1.22; I² = 0.0%; p < 0.001; n = 9), moderate (HR = 1.19; 95% CI: 1.07, 1.31; I² = 83.2%; p = 0.001; n = 10) and severe (HR = 1.52; 95% CI: 1.25, 1.86; I² = 94.9%; p < 0.001; n = 10). Additional subgroup analyses revealed a significant association between FI and both all-cause mortality (HR = 1.26; 95% CI: 1.18, 1.35; I² = 82.0%; p < 0.001; n = 16), and cardiovascular-related mortality (HR = 1.24; 95% CI: 1.11, 1.39; I² = 42.8%; p < 0.001; n = 7), but not cancer-related mortality. Conclusions: Persistent FI appears to contribute to an increased risk of mortality. Hence, it is important to maintain continuity and strengthen current programs aimed at combating FI, which may help reduce FI-related mortality.