Impact of food insecurity on cardiovascular mortality in united states: county-level analysis from 2014 to 2019
Authors: Sayed A , Aldosoky W , Mir T , Dar T , Abbasi T , Abohashem S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Food insecurity is a global public health challenge, that is defined as a social condition of limited or uncertain access to adequate food. Food insecurity is significantly linked to a myriad of negative health outcomes including high risk of cardiovascular (CV) morbidities and mortality. However, data on disparities of CV mortality attributable to food insecurity, is limited.

Purpose
We sought to investigate the independent association between food insecurity and cardiovascular mortality among age, gender, and race/ethnicity subgroups.

Methods
Age-adjusted CV mortality rates (ACVM) between 2014 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Food insecurity levels were obtained using the Core Food Insecurity Model. Census population estimates, CDC Diabetes Interactive Atlas, and the Behavioral Risk Factors Surveillance System, were utilized to acquire county-level demographics, rates of obesity, diabetes, and smoking data. Poisson generalized linear mixed models were employed to assess incidence rate ratios (IRR) of CV mortality associated with food insecurity while adjusting for other potential confounders. The burden of additional yearly deaths (AYD) per 100,000 individuals was calculated by multiplying the baseline CV death rates by the percentage increase attributable to food insecurity in each subgroup.

Results
Of 317,203,618 residents (49.6% men, 12.1% black) lived at 2878 US counties in 2014, total 4,933,002 (1.6%) CV deaths occurred between 2014-2019. In fully adjusted model*, food insecurity significantly associated with high levels of ACVM (IRR: 1.03; 95% CI: 1.02 to 1.04), that translated to 6.9 AYD per 100,000 individuals. Notably, food insecurity associated with a relatively higher ACVM among middle aged adults [45 to 64] (IRR: 1.04) as compared to elderly [≥65] (IRR: 1.02), and in non-Hispanic blacks (IRR: 1.05) versus non-Hispanic whites (IRR: 1.03). Interestingly, food insecurity had a relatively larger impact on middle aged adults among non-Hispanic whites (IRR: 1.07; 10.6 AYD), while among non-Hispanic blacks, elderly group were most impacted (IRR: 1.05; 76.5 AYD). Additionally, ACVM associated with food insecurity, was significantly similar among males (IRR: 1.03), and females (IRR: 1.03), with a greater impact among middle aged subgroup of each gender (IRR: 1.06; IRR: 1,04, respectively), (Figure).

Conclusion
Food insecurity is strongly associated with county-level age-adjusted CV mortality, independent of other well-established determinants of CV death, including CV risk factors, socioeconomic, environmental and health care access factors. Food insecurity has the greatest impact among those most vulnerable and disadvantaged, namely middle-aged adults and non-Hispanic black individuals. Accordingly, reducing levels of food insecurity, and addressing disparities in associated CV mortality rates, are an emergent public health priority.