According to new research published today in Circulation: Heart Failure, an American Heart Association journal, living in a community with easy access to grocery stores and affordable, healthy food is associated with lower heart failure death rates, according to a study that reviewed data from nearly 3,000 counties in the United States.
Food insecurity occurs when healthy food is in short supply on a daily basis as a result of poverty or socioeconomic challenges, causing people to go hungry or eat food of poor quality, variety, or desirability. While previous research has confirmed that food insecurity is associated with poor cardiovascular outcomes, little is known about the local food environment and its potential link to heart failure death.
A 2019 paper published in the Journal of the American Heart Association found that, on a county level in the U.S., poverty was the strongest socioeconomic factor associated with heart failure and coronary heart disease, and the association was stronger for heart failure than coronary heart disease.
“Heart failure mortality is on the rise in populations that live in socioeconomic deprivation, and, importantly, we believe that nutrition plays a role in heart failure mortality, and food insecurity may be particularly detrimental in this population,” said lead study author Keerthi T. Gondi, M.D., an internal medicine resident at the University of Michigan Health System in Ann Arbor, Michigan. “We know that important relationships exist among food access and food affordability and heart health. This will have to be addressed in order to make changes to the burden of cardiovascular disease in populations that live in socioeconomic deprivation moving forward.”
The study’s findings are unfortunate but not surprising. These findings are consistent with previous research that has shown a link between cardiovascular disease and food insecurity.
Anne Thorndike
This is one of the first studies to look into the link between local food environments and heart failure mortality. Heart failure is a chronic, progressive condition in which the heart muscle weakens to the point where it no longer pumps blood as efficiently as it should. According to Gondi, he and his colleagues looked at the heart failure death rate because it is a consistent metric reported across all US counties, allowing them to evaluate heart failure outcomes at the population level. According to the American Heart Association’s Heart Disease and Stroke Statistics Update for 2022, heart failure death accounted for nearly 86,000 deaths in the United States in 2019.
The researchers sought to determine whether food environment by county level was associated with heart failure death rates. They reviewed 2018 data from the National Vital Statistics System — a database of all births and deaths in the U.S. and examined the potential for associations among the heart failure death rates in each county with the county’s 2018 Food Insecurity Percentage score and Food Environment Index score.
The researchers collected each county’s Food Insecurity Percentage score – the percentage of the population who lack adequate, consistent access to healthy food and Food Environment Index score an index ranked from 0 (worst) to 10 (best) based on a composite of metrics including affordability of nutritious food, food insecurity, grocery store proximity, transportation and socioeconomic factors from the USDA’s Food Environment Atlas and the Robert Woods Johnson Foundation County Health Rankings. The Food Environment Atlas assembles statistics on food environment indicators and provides a spatial overview of a community’s ability to access healthy food.
Evaluated together, the Food Insecurity Percentage and Food Environment Index provide a clear picture of a population’s food environment.
Of the 2,956 counties in the study, the analysis found:
- The average Food Insecurity Percentage was 13% for all counties, and the average Food Environment Index score was 7.8.
- Counties with a Food Insecurity Percentage above the national median of 13.7% had a higher rate of deaths from heart failure compared to counties with a Food Insecurity Percentage below the median (30.7 deaths versus 26.7 deaths per 100,000 people, respectively).
- After adjusting for a range of socioeconomic and health factors — including the poverty rate, income inequity, rural vs. urban locations, Type 2 diabetes, obesity and smoking — a 1% decrease in Food Insecurity Percentage by county was associated with a 1.3% lower heart failure death rate. Similarly, a 1-unit increase in the Food Environment Index score by county was associated with a 3.6% decrease in the heart failure death rate.
- On the county level, decreases in the Food Environment Index and increases in the Food Insecurity Percentage were found to have a stronger association with the death rate from heart failure than with the death rate for other subtypes of cardiovascular disease, as well as with the all-cause death rate.
- The strongest association between food environment and heart failure death rate was found in counties with the highest income inequity and the highest poverty rate.
“The study’s findings are unfortunate but not surprising. These findings are consistent with previous research that has shown a link between cardiovascular disease and food insecurity “said Anne Thorndike, M.D., M.P.H., FAHA, director of the Cardiac Lifestyle Program at Massachusetts General Hospital in Boston, immediate past chair of the Association’s Nutrition Committee, and member of the Association’s Lifestyle Council, who was not involved in this study. “This study provides a robust evaluation of the food environment by U.S. counties and demonstrates that food environment characteristics are strongly associated with death from heart failure.”
A limitation of the study is that it only captures data from one year, before the COVID-19 pandemic, therefore, it may have limited generalization at this time. More studies are needed to examine these associations over a longer period of time.
The study also discovered that counties with higher heart failure death rates had fewer food stores, less access to healthy foods for adults over the age of 65, and a lower participation rate in SNAP, or the Supplemental Nutrition Assistance Program. SNAP is a federal government program that supplements food budgets to help reduce food insecurity for families and individuals with an annual income of at or below 130 percent of the federal poverty line (for a family of three, those with an annual income of less than $29,940 qualify for SNAP).
According to the Association’s Life’s Essential 8, one of the key contributors to cardiovascular disease risk is dietary intake, which is affected by food insecurity, and the low prevalence of ideal diet drives the overall low prevalence of ideal cardiovascular health in the United States. Improved cardiovascular health reduces the risk of heart disease, stroke, and other major health issues.
