Research Paper
Food insufficiency and food insecurity as risk factors for physical disability among Palestinian refugees in Lebanon: Evidence from an observational study

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Abstract

Background

Potential interactions between malnutrition and disability are increasingly recognized, and both are important global health issues. Causal effects working from nutrition to disability and from disability back to nutrition present an empirical challenge to measuring either of these effects. However, disability affects nutrition whatever the cause of disability, whereas nutrition is likelier to affect disease-related disability than war- or work-related disability.

Objective

This paper investigates the association of food insufficiency with the risk of physical disability. Data on disability by cause allow us to address the difficulty of reverse causality.

Methods

Multinomial logit regressions of disability by cause on food insufficiency are run using survey data from 2010 on 2575 Palestinian refugee households in Lebanon. Controls include household sociodemographic, health and economic characteristics. Regressions of food insufficiency on disability by cause are also run.

Results

Disability has a significant coefficient in regressions of food insufficiency, whatever the cause of disability; but in regressions of disability on food insufficiency, food insufficiency is significant only for disease-related disability (log odds of disease-related disability .78 higher, p = .008). The difference in the results by cause of disability is evidence of a significant association between food insufficiency and disease-related disability, net of any reverse effect from disability to food access.

Conclusions

The association between disease-related disability and food insufficiency is statistically significant suggesting that even taking into account feedback from disability to nutrition, nutrition is an effective level of intervention to avert the poverty-disability trap resulting from the impoverishing effect of disability.

Section snippets

Study design and covariates

A socio-economic survey was conducted by the American University of Beirut (AUB) and the United Nations Relief and Works Agency (UNRWA) in July–August 2010 on the living conditions of Palestinian refugees residing in Lebanon. This paper uses data from this survey and STATA 9.0 for Mac to run the statistical analyses. Table 1 lists the variables used with some summary statistics.

The survey covered 2575 eligible households living in 12 camps and 20 gatherings in five different areas: Central

Results

Table 1 presents the sociodemographic, food security and health characteristics of households surveyed. 55% of households had food insufficiency, whereas close to 62% were food insecure. 13% of households had a member with a known cause of disability, whereas 3% of households included a disabled individual of “other” cause.

In the regressions in Table 2 of nutritional profile variables on disability by cause, the excluded disability category is “disability of unknown cause,” therefore the

Discussion

When the associations of food insecurity, insufficiency and insufficient variety in the regression known cause disability is contrasted to their coefficients in the regression of disability of “other” causes, food insufficiency and insufficient food variety are not significant in predicting the relative odds of known-cause disability. By contrast, food insufficiency is significant in predicting the relative log odds of unknown cause disability. Furthermore, the magnitudes of the associations of

Conclusions

Parsing out the associations between a set of measures of food insecurity and disabilities by causes reveals the existence of a consistently significant and positive partial correlation between food insufficiency and disability specifically due to disease, even when controlling for chronic health conditions and household socio-economic status.

What is already widely known in the literature about the severely impoverishing effects of disability (regardless of cause) suggests that prevention

Acknowledgments

The authors acknowledge the excellent research assistance of Sami Ramly and Anniebelle Sassine. The authors also acknowledge Dr. Nuha Nuwayri-Salti for contributions to a previous draft of the abstract.

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    A previous version of the abstract (co-authored with Dr. Nuha Nuwayri-Salti) was published as “Disability and food insufficiency in the Palestinian refugee population in Lebanon: a household survey” at http://dx.doi.org/10.1016/S0140-6736(13)62603-3 as part of the abstracts published in The Lancet, Volume 382, Special Issue S31, 5 December 2013, of the proceedings of the Lancet Palestine Health Alliance Conference.

    Disclosures: The data was collected as part of the United Nations Relief and Works Agency (UNRWA) (grant title “UNRWA-AUB Socio-Economic Survey of Palestine Refugees in Lebanon”) service grant. The authors declare that they have no conflict of interest.

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