DALLAS, Nov. 9, 2020 -- Increasing rates of food insecurity in counties across the U.S. are independently associated with an increase in cardiovascular death rates among adults between the ages of 20 and 64, according to preliminary research to be presented at the American Heart Association's Scientific Sessions 2020. The meeting will be held virtually, Friday, November 13 - Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research, evidence-based clinical practice updates in cardiovascular science for health care worldwide.
About 10% of adults in the U.S. are considered food insecure, meaning they lack immediate access to fresh, healthy and affordable food. In addition, the stress from not knowing where their next meal will come from or regularly consuming cheap, processed foods may have an adverse impact on cardiovascular health.
"Our study is one of the first national analyses to look at changes in both food insecurity and cardiovascular mortality over time, and to see if changes in food insecurity impact cardiovascular health," said study co-author Sameed Khatana, M.D., M.P.H., instructor of cardiovascular medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. "This research shows food insecurity, which is a particular type of economic distress, is associated with cardiovascular disease. It illustrates that cardiovascular health is tied to many things. It's more than doctors' visits, screenings, medications and procedures; what is going on outside the clinic, in society, has a significant impact on patients' health, too."
Researchers accessed both the National Center for Health Statistics and the Map the Meal Gap study to analyze county-level data on cardiovascular death rates and food insecurity rates that occurred from 2011 to 2017, among adults age 20 to 64, and those 65 years old and older.
In their analysis, researchers examined cardiovascular mortality trends in the U.S. by average annual percent change in food insecurity. They assessed the relationship between changes in food insecurity and cardiovascular death rates, after adjusting for variables including changes in demographics, employment, poverty, income, health insurance and other factors already known to affect cardiovascular risk.
Among the key findings:
- Overall, food insecurity rates for the entire country declined significantly (from 14.7% to 13.3%) between 2011 and 2017.
- The level in which food insecurity changes was a significant predictor of death for people between the ages of 20 and 64. U.S. counties that had the most increase in food insecurity levels had cardiovascular death rates that increased from 82 to 87 per 100,000 population. Counties that had a decrease in food insecurity had a cardiovascular mortality rate that remained stable at 60 per 100,000 population.
- Cardiovascular death rates remained much higher among the elderly (age ?65) than for people 64 and younger, yet the rate of deaths did decline at all levels: from 1,643 to 1,542 per 100,000 population among those who experienced the most change in food insecurity levels, and from 1,408 to 1,338 per 100,000 population among those who had the least change. The changes were not scientifically significant.
- For every 1% increase in food insecurity, there was a similar increase in cardiovascular mortality among non-elderly adults (0.83%).
"Overall, food insecurity rates did go down. However, while economic levels have improved when the country is measured as a whole, there has been a growing disparity demonstrating that parts of the country are being left behind," said Khatana.
Mercedes R. Carnethon Ph.D., FAHA, a member of the American Heart Association's Council on Epidemiology and Prevention Leadership Committee, said the analysis is comprehensive with some concerning trends.
"We know food insecurity and other social determinants of health can adversely impact heart and stroke risk factors like high blood pressure and diabetes, and this impact is disproportionately higher among traditionally underrepresented racial and ethnic groups," said Carnethon, the Mary Harris Thompson Professor and Vice Chair of the Department of Preventive Medicine in the Feinberg School of Medicine at Northwestern University in Chicago. "Social determinants of health are likely to worsen against the backdrop of the COVID-19 pandemic. The effects will extend beyond this period of time and lead to future elevations in cardiovascular diseases among vulnerable populations. Unfortunately, the outlook is not favorable, and major societal infrastructure changes are necessary to improve this situation."
In the future, the authors intend to study whether interventions that improve food insecurity would, in fact, lead to better cardiovascular health.
"When policy makers are thinking about the cardiovascular health of communities, they need to consider things like food insecurity, as well as the overall social and economic well-being of the community," Khatana said. "Interventions that improve the economic well-being of a community could lead to improvements in cardiovascular health of the people living there."
Co-authors are Stephen Y. Wang, M.D., M.P.H.; Atheendar S. Venkataramani, M.D., Ph.D.; Christina A. Roberto, Ph.D.; Lauren A. Eberly, M.D., M.P.H.; and Peter W. Groeneveld, M.D., M.S. Author disclosures are in the abstract. The authors reported no external funding for this study.
This abstract will be presented in Session QU.AOS.765 Social Determinants of Cardiovascular Health.
Multimedia, including a video perspective interview with Mercedes R. Carnethon Ph.D., FAHA, a member of the American Heart Association's Council on Epidemiology and Prevention Leadership Committee and the Mary Harris Thompson Professor and Vice Chair of the Department of Preventive Medicine in the Feinberg School of Medicine at Northwestern University in Chicago, may be downloaded from the right column of the release link https://newsroom.heart.org/news/food-insecurity-linked-to-higher-risk-of-cardiovascular-death?preview=d4805d239a85d841ae82ba6904af0455
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