Persistent Food Insecurity Inequities by age, gender, race/ethnicity, and educational attainment among US Adults with and without Symptoms of Anxiety and Depression: Using Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA).

Food insecurity has increased with inequities likely patterned by intersecting social identities/positions like education and race/ethnicity. Anxiety or depression symptoms may restrict material resources and increase food insecurity. Using intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA), we examined whether inequities in persistent food insecurity based on age, gender, race/ethnicity, and education were modified by anxiety or depression symptoms. In a national cohort of adults (n=4,933) followed over 2021-2023, 23% experienced food insecurity, with a higher prevalence among those with symptoms (49%). In the null model, 20% of the variance in food insecurity lies in the intersectional social strata. Age, gender, race/ethnicity, and education explained 99% of the between-stratum variance among adults with and 94% among adults without symptoms. Predicted probabilities of food insecurity were highest among adults younger than 55 years, non-college-educated, identified as Black and Hispanic. Symptoms of anxiety and depression were associated with 14-38 percentage point increase in predicted food insecurity. One stratum comprising White women aged 40-54 years without a college education or symptoms experienced food insecurity that deviated from the expected average effects. Findings suggest addressing food insecurity inequities tied to social positioning using universal proportionate interventions that integrate mental health support.