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Indicator Details: Annual Trends of Food Insecurity and Chronic Kidney Disease in the United States
Data Sources
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Full = Food secure

Marginal = Food insecure without hunger

Poor= Food insecure with moderate hunger

Very poor = Food insecure with severe hunger

Food insecurity is when a person does not have reliable access to enough nutritional and affordable food.

Chart Explanation: 

Among individuals with either early stage CKD (stages 1 and 2) or advanced stage CKD (stages 3 and 4), food insecurity (food insecurity without hunger, with moderate hunger, or with severe hunger) increased over the decade.[BNR(1]  In 2013–2014, 38% of US adults with early CKD and 25% of US adults with advanced CKD did not have access to enough nutritional and affordable food, also known as being food insecure.

The NHANES surveys are currently conducted every 2 years by the CDC's National Center for Health Statistics (NCHS) to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized U.S. civilian residents. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES.

Description of Measure

Household food security

Data Source


Type of Data Source


Health Care System Data


Regional or National?


Demographic Group

Noninstitutionalized US residents aged 20+ years


Household food security


Individuals with CKD (Stages 1-2 and Stages 3-4)

Definition of Food Security

Food security: household full food security: no affirmative response in any of these items. Food insecurity: household marginal food security: 1-2 affirmative responses; household low food security: 3-5 affirmative responses for household without children younger than 18 years, 3-7 affirmative responses for household with children; household very low food security: 6-10 affirmative responses for household without children younger than 18 years, 8-18 affirmative responses for household with children

Definition of CKD

Early Stage: Stage 1, eGFR > 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single albuminuria Advanced Stage: Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded

Glomerular filtration rate

Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ  x 0.993age x (1.018 if female) x (1.159 if NH Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male

Primary Indicator Method of Measurement

Questionnaire (Household food security)

Primary Variable

18 items: FSD032a, FSD032b, FSD032c, FSD032d, FSD032e, FSD032f, FSD041, FSD052, FSD061, FSD071, FSD081, FSD092, FSD102, FSD111, FSD122, FSD132, FSD141, and FSD146

Secondary Indicator Method of Measurement


Secondary Variable


Frequency of Measurement

Once (cross-sectional)

US Region Covered by Primary Variable


Period Currently Available


Pending Data


Additional Data Items of Interest

Demographic data (age, gender, race/ethnicity, SES); CKD risk factors  (BMI, diabetes, hypertension)


BMI = body mass index; eGFR = estimated glomerular filtration rate; NH = non-Hispanic; SES = socioeconomic status.

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd