Poor food environment, food insecurity linked to higher HF mortality in US
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Food environment may play a significant role in the county-level rate of HF mortality in the U.S., according to a study published in Circulation: Heart Failure.
“Food insecurity has emerged as a very important driver of cardiovascular disease, and it is possible that the pandemic has amplified this relationship. For clinicians, it will be increasingly important to identify patients at risk for or already suffering from food insecurity in order to provide them with resources or a directed care plan,” Keerthi T. Gondi, MD, internist at the University of Michigan Health System in Ann Arbor, told Healio.
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“There is an important association between food insecurity and HF mortality at the population level in the U.S., and this relationship is amplified and worse in communities with high rates of poverty and income inequity,” Gondi said. “Counties with higher burden of HF mortality have additional disparities across several realms of food insecurity, including affordability, transportation access, food store density and food assistance programs. These findings demonstrate the importance of food insecurity on HF and CVD at a population level.”
To better understand the potential effect of food environment on HF mortality rates, researchers queried the National Vital Statistics System and U.S. Department of Agriculture Food Environment Atlas to collect data related to HF mortality and food environment indices, such as county-level food insecurity percentage and food environment index.
Food insecurity percentage was defined as the percentage of the population that did not have access to a reliable source of food during the past year using data from the Community Population Survey, Bureau of Labor Statistics and American Community.
The food environment index is a scale from 0 to 10 — with 10 being the best — designed to determine whether a community is a food desert based on factors including food access, food security, proximity to stores, income and local geographic and socioeconomic factors.
Food insecurity and HF mortality
Across 2,956 counties, the mean food insecurity percentage was 13% and the mean food environment index was 7.8.
Researchers observed that counties with a food insecurity percentage of more than 13% had a greater rate of HF mortality compared with counties with a lower food insecurity percentage (30.7 per 100,000 people vs. 26.7 per 100,000 people; P < .001).
After adjustment for county-level demographic, socioeconomic and health factors, lower food insecurity percentage (beta per 1% decrease, 1.3%) and higher food environment index (beta per 1 unit increase, 3.6%) were associated with a lower rate of HF mortality.
Although county-level food insecurity percentage was associated with both HF- and non-HF CVD-related mortality, the association was stronger for HF mortality (beta per 1% decrease in food insecurity percentage, 0.7% vs. 1.3%).
County-level food environment index was not associated with non-HF CVD mortality in the fully adjusted model, according to the study.
Characteristics of counties with high HF mortality
Moreover, counties with HF mortality rates above the national average (32.6 per 100,000 persons) had a higher proportion of population with low access to stores and limited transportation; a higher proportion of population age 65 years or older; and a lower density of grocery stores and supercenters compared with counties below the national average (P for all < .001).
“Though patient-level intervention by clinicians is crucial, food insecurity must primarily be addressed with population-level interventions by policymakers and health systems. Community-level interventions will require addressing multiple realms across the spectrum of food insecurity including financial limitations, transportation limitations, access to food stores and food assistance programs,” Gondi told Healio. “I believe cardiologists can and should lead the way in addressing social determinants of health, which are large drivers of morbidity and mortality in patients with HF.”
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