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

• 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
• Journal Title: Journal of the American Heart Association
• Volume: Volume 8, Number 4
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial | 2019-02-19, Pages e010694-e010694
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.118.010694
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; cardiovascular disease; death; environment; food desert; myocardial infarction; socioeconomic position; CORONARY-HEART-DISEASE; NEIGHBORHOOD CHARACTERISTICS; ATHEROSCLEROSIS RISK; SOCIOECONOMIC-STATUS; UNITED-STATES; OBESITY; ENVIRONMENT; HEALTH; URBAN; MORTALITY

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.