Regional and social inequalities in food insecurity in Brazil, 2013-2018.

This study aims to analyze the association between social indicators and the worsening of food insecurity in 2013 and 2018 in different regions of Brazil. Data from the Brazilian National Household Sample Survey (2013) and Brazilian Household Budgets Survey (2018) were analyzed, considering nationally representative samples of 110,750 and 57,920 households, respectively. Food insecurity was assessed using the Brazilian Food Insecurity Scale by estimating the percentage changes in food insecurity levels between 2013 and 2018, according to sociodemographic variables. The association between social indicators and food insecurity disaggregated by region was estimated using multinomial logistic regression models. Although North and Northeast regions had higher proportions of food insecurity, the Southeast and Central-West regions had the highest increase in food insecurity in the same periods. Income was the indicator with the highest association with food insecurity both in 2013 and 2018. We also observed the association between the presence of three or more residents aged under 18 in a household and a higher risk of food insecurity in North and South regions. Food insecurity increased unevenly among regions during the Brazilian economic crisis, which reinforced regional inequality. Moreover, food insecurity was greater among households with worse social and economic living conditions, contributing to social inequality in the country. Thus, strengthening public policies to promote food security and nutrition according to regional social inequities is necessary.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil / Desigualdades na aquisição de alimentos de acordo com a renda e os perfis sociais do chefe de família no Brasil

Abstract Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Resumo O Brasil é caracterizado por fortes desigualdades sociais e diferenças no acesso a alimentos de qualidade e em quantidade suficiente, o que representa uma violação do direito humano à alimentação adequada. O objetivo foi avaliar os gastos com alimentação de acordo com o perfil social do responsável pelo domicílio. Dados da Pesquisa de Orçamentos Familiares Brasileiros de corte transversal (2017/2018) foram usados com uma amostra nacionalmente representativa de participantes da pesquisa domiciliar (n=52.917). A regressão de Poisson foi utilizada para estimar razões de prevalência (RP) para avaliar a associação de diferentes perfis sociais com a aquisição de alimentos. O perfil caracterizado pela mulher auto classificada como branca, com maior escolaridade, cujas características estiveram positiva e significativamente associadas a maior aquisição de frutas (RP=1,22; IC95% 1,09-1,36), verduras e legumes (PR=1,24; IC95% 1,09-1,41) e queijo (RP=1,32; IC95% 1,09-1,59). Mulheres negras com baixa escolaridade apresentaram associação negativa com o consumo de refrigerantes (RP=0,53; IC95% 0,45-0,62) e alimentos preparados (RP=0,52; IC95% 0,37-0,74). Os resultados revelam grandes desigualdades na aquisição de alimentos entre os perfis sociais dos chefes de família.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil.

Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Relationship between social indicators and food insecurity: a systematic review.

INTRODUCTION: 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.

Relationship between social indicators and food insecurity: a systematic review / Relação entre indicadores sociais e insegurança alimentar: uma revisão sistemática

ABSTRACT: Introduction: 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.

RESUMO: Introdução: As relações existentes entre os indicadores sociais (IS) que determinam a insegurança alimentar (IA) ainda não foram descritas. Esta revisão sistemática se propõe a identificar os IS que se associam com a IA em domicílios brasileiros e como essa relação é explicada. Metodologia: O protocolo de pesquisa foi registrado no PROSPERO (CRD42018106527). A busca dos artigos foi realizada por três pesquisadoras independentes nas bases Lilacs e PubMed (junho/2018). O estudo incluiu artigos que utilizaram a Escala Brasileira de Insegurança Alimentar (EBIA) para avaliar a IA e que analisaram a associação entre IS e IA. Resultados: 18 artigos foram incluídos nessa revisão. O índice de concordância Kappa entre as pesquisadoras foi de 0,72 (IC95% 0,42 - 1,00). A maioria dos artigos foram do tipo transversais e utilizaram regressão multivariada para análise de dados. Pelo menos um IS relacionado à renda teve associação significativa com a IA e, na maioria dos estudos, eles foram os que apresentaram os maiores valores das medidas de associação. A justificativa dos autores sobre as relações entre IS e IA foram organizadas em um modelo conceitual. O estudo identificou 3 possibilidades de explicar a associação entre IS e IA: relação direta, relação mediada pela renda, ou por outro IS e renda. Conclusão: A renda assumiu um papel central na mediação de diversos IS com IA. Entretanto, os métodos de análise dos estudos não possibilitaram lidar com essa mediação, portanto aprimoramentos nas análises de dados são necessários para isolar e compreender o efeito dos IS na IA.