Access to Healthy Food Found to Impact Risk of Heart Failure Death

Food insecurity has previously been linked to adverse cardiovascular outcomes, but research is limited regarding the local food environment and the association with death from heart failure.

Living in a community that allows easy access to affordable and healthy food is associated with lower rates of death from heart failure, according to a study published in Circulation: Heart Failure.

The invesitgators defined food insecurity as healthy food not being readily available daily because of poverty or socioeconomic challenges, which may lead to people going hungry or consuming food of lesser quality, variety, and desirability.

Food insecurity has previously been linked to adverse cardiovascular outcomes, but research is limited regarding the local food environment and the association with death from heart failure. The study authors noted that in 2019, poverty was found to be the strongest socioeconomic factor associated with heart failure and coronary heart disease at a county level in the United States. They also found this association was stronger for heart failure than for 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, MD, an internal medicine resident at the University of Michigan Health System in Ann Arbor, Michigan, in a press release. “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 researchers examined the death rate from heart failure because it is a consistent metric reported across all US counties. These data allow the investigators comprehensively analyze heart failure outcomes at the population level and whether there is a link between food environment by US county level and heart failure death rates.

The team reviewed 2018 data from the National Vital Statistics System, a database of all births and deaths in the United States. They looked for potential associations among the heart failure death rates in each county with the county’s 2018 Food Insecurity Percentage score and Food Environment Index score.

Food Insecurity Percentage score is the percentage of the population who lack adequate and consistent access to healthy food. The Food Environment Index score is based on a composite of metrics ranking from 0 (worst) to 10 (best) in areas such as affordability of nutritious food, food insecurity, grocery store proximity, transportation, and socioeconomic factors, from the USDA’s Food Environment Atlas and the Robert Wood Johnson Foundation County Health Rankings. Further, the Food Environment Atlas collects statistics on food environment indicators and provides a big picture outlook of a community’s ability to access healthy food.

After examining 2956 US counties, the study showed the average Food Insecurity Percentage was 13% for all counties, whereas the average Food Environment Index score was 7.8. Counties with a Food Insecurity Percentage above the national median of 13.7% were found to have an increased rate of deaths from heart failure compared with counties that had a Food Insecurity Percentage below the median.

After the investigators adjusted for several socioeconomic and health factors, including poverty rate, income inequity, rural vs urban locations, type 2 diabetes, obesity, and smoking, they found that a 1% drop in the Food Insecurity Percentage by county was associated with a 1.3% lower heart failure death rate. Additionally, they found that a 1-unit increase in the Food Environment Index score by county was associated with a 3.6% reduction in the heart failure death rate.

Declines in the Food Environment Index and increases in the Food Insecurity Percentage at the county level showed 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 findings of this study are unfortunate yet not surprising. These results are consistent with prior studies that have demonstrated the association of cardiovascular disease and food insecurity,” said Anne Thorndike, MD, MPH, FAHA, director of the Cardiac Lifestyle Program at Massachusetts General Hospital in Boston, immediate past chair of the Association’s Nutrition Committee and a member of the Association’s Lifestyle Council, in a press release. “This study provides a robust evaluation of the food environment by US counties and shows that characteristics of the food environment are strongly associated with death from heart failure.”

One study limitation was that it only captured data over the course of 1 year prior to the start of the COVID-19 pandemic, which may have limited generalization at this time. The investigators said that further research is needed to examine these associations over a longer period.

“Food insecurity and lack of access to healthy food are key contributors to poor dietary quality and what is referred to as ‘nutrition insecurity,’” Thorndike said in a press release. “The American Heart Association and others are now acknowledging that to help Americans achieve ideal cardiovascular health, particularly ideal diet, we need to broaden our efforts to address both the psychological and social determinants of our health behaviors and well-being. These efforts need to include policy, health care, and community interventions that improve access to nutritious food for people at every stage of life.”

REFERENCE

Lack of access to healthy food may raise risk of death from heart failure. American Heart Association. October 25, 2022. Accessed October 25, 2022. https://newsroom.heart.org/news/lack-of-access-to-healthy-food-may-raise-risk-of-death-from-heart-failure?preview=6325