Relation of Living in a "Food Desert" to Recurrent Hospitalizations in Patients With Heart Failure

• Type of Material: Article
• Authors: Alanna Morris, Emory University; Paris McAllister, Morehouse School of Medicine; Aubrey Grant, Emory University; Siyi Geng, Emory University; Heval M. Kelli, Emory University; Andreas Kalogeropoulos, Emory University; Arshed Quyyumi, Emory University; Javed Butler, Emory University
• Language: English
• Date: 2019-01-15
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2018.10.004
• Title of Journal or Parent Work: American Journal of Cardiology
• ISSN: 0002-9149
• Volume: 123
• Issue: 2
• Start Page: 291
• End Page: 296
• Grant/Funding Information: A.A.M is supported by funding from the NIH/NHLBI (K23 HL124287) and the Robert Wood Johnson Foundation (Harold Amos Medical Faculty Development Program).
• Keywords: Science & Technology; RISK; Life Sciences & Biomedicine; MORTALITY; NEIGHBORHOOD; INSECURITY; Cardiac & Cardiovascular Systems; IMPACT; SOCIOECONOMIC-STATUS; Cardiovascular System & Cardiology
• Research Categories: Health Sciences, Nutrition; Health Sciences, Medicine and Surgery; Sociology, Public and Social Welfare

Abstract

Food deserts (FD), low-income areas with low access to healthful foods, are associated with higher burden of cardiovascular risk factors. Few studies have examined the impact of FD on clinical outcomes in heart failure (HF). FD status was assessed in 457 HF patients (mean age 55.9 ± 12.5 years; 50.3% Black) using the Food Desert Research Atlas. The Andersen-Gill extension of Cox model was used to examine the association of living in a FD with risk of repeat hospitalization (all-cause and HF-specific). Patients living in a FD were younger (p = 0.01), more likely to be Black (p <0.0001), less educated (p = 0.003), and less likely to have commercial insurance (p = 0.003). During a median follow-up of 827 (506, 1,379) days, death occurred in 60 (13.1%) subjects, and hospitalizations occurred in 262 (57.3%) subjects. There was no difference in the risk of death based on FD status. The overall frequency of all-cause (94.1 vs 63.6 per 100 patient-years) and HF-specific (59.6 vs 30.5 per 100 patient-years) hospitalizations was higher in subjects who lived in a FD. After adjustment for covariates, living in a FD was associated with an increased risk of repeat all-cause (hazard ratio 1.39, 95% confidence interval 1.19 to 1.63; p = 0.03) and HF-specific (hazard ratio 1.30, 95% confidence interval 1.02 to 1.65; p = 0.03) hospitalizations. In conclusion, patients living in a FD have a higher risk of repeat all-cause and HF-specific hospitalization.