Food Insecurity Is Independently Associated With Heart Failure Mortality In The United States

Abstract

<h3>Introduction/Hypothesis</h3> Food access and nutrition disparities are known contributors to overall and cardiovascular health, but the quantitative effect on heart failure (HF) mortality is not known. We hypothesize that food insecurity is independently associated with HF mortality at a population-level. <h3>Methods</h3> We utilized the National Death Index and the USDA Food Environment Atlas database to collect data on county-level HF mortality rate and indices of food security, socioeconomics, and medical comorbidities. Food environment index (FEI) is a standardized index (0-10) weighing both food insecurity and access to healthy foods. Linear regression was performed to determine the association between FEI and HF mortality. <h3>Results</h3> Mean age-adjusted HF mortality rate was 30.0 per 100,000 persons in 859 counties that reported mortality data. Counties with low FEI were more non-white and un-insured, had higher income inequity, and had higher incidence of obesity, diabetes, and cigarette use (all <i>p</i><0.0001). Mean FEI was 7.5, and counties with FEI ≥7.5 had a significantly lower age-adjusted HF mortality rate compared to FEI <7.5 (26.4 vs 32.8, <i>p</i> <0.0001). Counties with lower HF mortality rates had higher density of grocery stores, supercenters, SNAP-authorized stores, and WIC-authorized stores (all <i>p</i><0.0001). Higher FEI was independently associated with reduction in age-adjusted HF mortality rate in a demographics-adjusted model (RR 0.77 per 1 unit increase in FEI, 95% CI, 0.73 to 0.82, <i>p</i> <0.0001) and a fully adjusted model accounting for demographic, socioeconomic, and medical factors (adjusted R² = 0.27, RR 0.95 per 1 unit increase in FEI, 95% CI, 0.91-0.99), <i>p</i> = 0.04). <h3>Conclusion</h3> Counties with high HF mortality rates have lower food security, food access, density of food stores, and density of stores accepting food assistance programs. Higher FEI is associated with reduction in HF mortality. Food access disparities are a potential target for improvement in HF outcomes.