Abstract
BackgroundMillions of Americans are living in food deserts in the United States, however the role of the local food environment on COPD has not been studied. The aim of this study is to determine the association between food deserts and COPD-related outcomes.MethodIn this cross-sectional analysis we linked data collected from SPIROMICS (SubPopulations and InteRmediate Outcome Measures in COPD Study) between 2010 and 2015 and food desert data, defined as an underserved area that lacks access to affordable healthy foods, from the Food Access Research Atlas. COPD outcomes include percentage of predicted forced expiratory volume in one second (FEV1%), St. George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), 6-min walk distance test (6MWD), exacerbations, and air trapping. We used generalized linear mixed models to evaluate the association between living in food deserts and respiratory outcomes, adjusting for age, gender, race, education, income, marital status, BMI, smoking status, pack years, and urban statusResultsAmong 2713 participants, 22% lived in food deserts. Participants living in food deserts were less likely to be white and more likely to have a lower income than those who did not live in food deserts. In the adjusted model controlling for demographics and individual income, living in food deserts was associated lower FEV1% (β = – 2.51, P = 0.046), higher air trapping (β = 2.47, P = 0.008), worse SGRQ (β = 3.48, P = 0.001) and CAT (β = 1.20, P = 0.003) scores, and 56% greater odds of severe exacerbations (P = 0.004). Results were consistent when looking at food access alone, regardless of whether participants lived in low income areas.ConclusionsFindings suggest an independent association between food desert and food access alone with COPD outcomes. Health program planning may benefit from addressing disparities in access to food.
Highlights
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States (U.S.) and the world, with almost 6% of the population in the United States having COPD [1,2,3]
In the adjusted model controlling for demographics and individual income, living in food deserts was associated lower FEV1% (β = – 2.51, P = 0.046), higher air trapping (β = 2.47, P = 0.008), worse St. George’s Respiratory Questionnaire (SGRQ) (β = 3.48, P = 0.001) and COPD Assessment Test (CAT) (β = 1.20, P = 0.003) scores, and 56% greater odds of severe exacerbations (P = 0.004)
Results were consistent when looking at food access alone, regardless of whether participants lived in low income areas
Summary
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States (U.S.) and the world, with almost 6% of the population in the United States having COPD [1,2,3]. Several studies have investigated the association of food deserts, defined as underserved areas that lack access to affordable healthy foods, with health outcomes [12,13,14,15,16]; the association between food desert and COPD has not yet been established. It is empirically difficult to distinguish whether these associations are due to low socioeconomic status (SES) factors or low food access; that is, areas where more than onethird of the population have limited access to the nearest supermarket [12,13,14,15,16]. No currently published studies have investigated the association between food desert, nor low food access areas, and COPD outcomes. The aim of this study is to determine the association between food deserts and COPD-related outcomes
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