Abstract 14445: Patients With Peripheral Artery Disease Living in Food Deserts Are Associated With Worse Outcomes and Suboptimal Medical Therapy

Abstract

Introduction: Major adverse cardiac events (MACE) represent important clinical outcomes for patients with PAD, while also disproportionally impacting minority populations. Guideline-directed optimal medial therapy (OMT) is known to reduce MACE events, but whether the OMT-adjusted rate of MACE events are influenced by social determinants of health, including living in a food desert (FD) has not been previously explored. Methods: Patients with PAD from a single-system registry were geocoded as living in a FD vs non-FD according to the US Department of Agriculture Food Access Research Atlas. FDs are characterized as census tracts with low income and poor food access (defined as proximity to a grocery store). MACE was defined as a composite of all-cause death, acute myocardial infarction, or stroke. OMT was defined as being prescribed antiplatelet, statin, renin-angiotensin inhibitors, and with tobacco abstention. Cox proportional hazards models examined the association of area characteristics (FD, poor access, low income) and MACE, adjusted for traditional factors. Multivariable logistic regression examined the association of demographic, clinical, and area characteristics with OMT. Results: From 2015 to 2021, 1,834 (15.4%) of 11,907 lived in FDs. Patients in FDs were more likely Black or Hispanic, residing in urban areas, had low vehicle access, and had a higher prevalence of hypertension, diabetes, and chronic kidney disease. Those living in FDs had a higher adjusted risk of MACE (HR 1.17 [1.04-1.31], p=0.008) driven by all-cause death (HR 1.19 [1.03-1.37], p=0.018). Female sex, malnutrition, COPD, CKD, and low area income were significantly associated with lower odds of achieving OMT. Conclusions: Living in food deserts is a major barrier to optimizing care and improving outcomes among patients with PAD. Future prospective studies should examine the impact of community and health policy interventions that mitigate poor food access.