Abstract
ObjectiveTo examine the relationship between food swamps and hospitalization rates among adults with diabetes.Data SourcesBlue Cross Blue Shield Association Community Health Management Hub® 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010‐2014.Study DesignCross‐sectional analysis of 784 counties across 15 states. Food swamps were measured using a ratio of fast food outlets to grocers. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Population‐weighted models were controlled for comorbidities; Medicaid; emergency room utilization; percentage of population that is female, Black, Hispanic, and over age 65; and state fixed effects. Analyses were stratified by rural‐urban category.Principal FindingsAdults with diabetes residing in more severe food swamps had higher hospitalization rates. In adjusted analyses, a one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all‐cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care‐sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all‐cause hospitalization rate relationship was stronger in rural counties than urban counties.ConclusionsFood swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity.
Highlights
Health care providers and systems are increasingly being incentivized to improve the management of chronic conditions while simultaneously reducing costs of care
If food swamps are associated with obesity through dietary intake, it is likely that, in addition, adults with diabetes residing in food swamps are more vulnerable and prone to diabetic exacerbations and complications caused by poor dietary intake
The models utilizing the number of hospitalizations conditional on the number of adults with diabetes rather than the hospitalization rate indicate that higher food swamp scores remain strongly significantly associated with greater all-cause hospitalizations and ambulatory care-sensitive conditions (ACSC) hospitalization rates
Summary
To examine the relationship between food swamps and hospitalization rates among adults with diabetes. Data Sources: Blue Cross Blue Shield Association Community Health Management Hub® 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010-2014. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Principal Findings: Adults with diabetes residing in more severe food swamps had higher hospitalization rates. A one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all-cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care-sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all-cause hospitalization rate relationship was stronger in rural counties than urban counties. Conclusions: Food swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity
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