Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients With Cardiovascular Disease

• Type of Material: Article
• Authors: Heval M. Kelli, Emory University; Jeong Hwan Kim, Emory University; Ayman Samman Tahhan, Emory University; Chang Liu, Emory University; Yi-An Ko, Emory University; Muhammad Hammadah, Emory University; Samaah Sullivan, Emory University; Pratik Sandesara, Emory University; Ayman A. Alkhoder, Emory University; Fahad K. Choudhary, Emory University; M. Mazen Gafeer, Emory University; Keyur Patel, Emory University; Saqib Qadir, Emory University; Tene T. Lewis, Emory University; Viola Vaccarino, Emory University; Laurence S Sperling, Emory University; Arshed Ali Quyyumi, Emory University
• Language: English
• Date: 2019-02-19
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.118.010694
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 8
• Issue: 4
• Start Page: e010694
• End Page: e010694
• Grant/Funding Information: Dr Quyyumi is supported by NIH grants 5P01HL101398‐02, 1P20HL113451‐01, 1R56HL126558‐01, 1RF1AG051633‐01, R01 NS064162‐01, R01 HL89650‐01, HL095479‐01, 1U10HL110302‐01, 1DP3DK094346‐01, 2P01HL086773, and the American Heart Association Grant no. 0000031288. Drs Kelli, Kim, Samman Tahhan, and Sandesara are supported by the Abraham J. and Phyllis Katz Foundation.; Additional funding sources include NHLBI T32 THL130025A for Drs Kelli and Sullivan, the American Heart Association Grant no. 0000031288 for Dr Kim, and the National Institutes of Health/National Institute on Aging grant AG051633 for Dr Samman Tahhan, and NIH K12HD085850 for Dr. Sullivan.
• Keywords: Cardiovascular System & Cardiology; NEIGHBORHOOD CHARACTERISTICS; Cardiac & Cardiovascular Systems; UNITED-STATES; cardiovascular disease; myocardial infarction; MORTALITY; OBESITY; Life Sciences & Biomedicine; ATHEROSCLEROSIS RISK; socioeconomic position; food desert; CORONARY-HEART-DISEASE; HEALTH; URBAN; Science & Technology; SOCIOECONOMIC-STATUS; environment; death; ENVIRONMENT
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background—Food deserts (FDs), defined as low-income communities with limited access to healthy food, are a growing public health concern. We evaluated the impact of living in FDs on incident cardiovascular events. Methods and Results—We recruited 4944 subjects (age 64±12, 64% male) undergoing cardiac catheterization into the Emory Cardiovascular Biobank. Using the US Department of Agriculture definition of FD, we determined whether their residential addresses had (1) poor access to healthy food, (2) low income, or (3) both (=FD). Subjects were prospectively followed for a median of 3.2 years for myocardial infarction (MI) and death. Fine and Gray’s subdistribution hazard models for MI and Cox proportional hazard models for death/MI were used to examine the association between area characteristics (FD, poor access, and low income) and the rates of adverse events after adjusting for traditional risk factors. A total of 981 (20%) lived in FDs and had a higher adjusted risk of MI (subdistribution hazard ratio, 1.44 [95% CI, 1.06–1.95]) than those living in non-FDs. In a multivariate analysis including both food access and area income, only living in a low-income area was associated with a higher adjusted risk of MI (subdistribution hazard ratio, 1.40 [1.06–1.85]) and death/MI (hazard ratio, 1.18 [1.02–1.35]) while living in a poor-access area was not significantly associated with either (subdistribution hazard ratio, 1.05 [0.80–1.38] and hazard ratio, 0.99 [0.87–1.14], respectively). Conclusions—Living in an FD is associated with a higher risk of adverse cardiovascular events in those with coronary artery disease. Specifically, low area income of FDs, not poor access to food, was significantly associated with worse outcomes.