Lack of access to healthy food can increase the risk of death from heart failure

A study examining data from nearly 3,000 U.S. counties found that 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 new study published today in Circulation: Heart Failure.

Food security occurs when healthy food not available every day due to poverty or socio-economic problems, resulting in people going hungry or eating food of poor quality, variety or desirability. While previous studies have confirmed this food safety associated with adverse cardiovascular outcomes, there is little research on local food environment and its potential association with death from heart failure. 2019 document published in Journal of the American Heart Association found that at the county level in the US, poverty was the strongest socioeconomic factor associated with heart failure and coronary heart disease, and the association was stronger for heart failure than ischemic heart disease.

“Heart failure mortality increases in socioeconomically disadvantaged populations, and importantly, we believe that nutrition plays a role in heart failure mortality, and food insecurity can be particularly detrimental to this population.” , said lead study author Kirti T. Gondi, MD, an internist at the University of Michigan Health System in Ann Arbor, Michigan. “We know that there is an important relationship between us access to food and food availability and heart health. This will need to be addressed to change the burden of cardiovascular disease in a population living in socioeconomic deprivation to move forward.”

This study is one of the first analyzes to examine the association between the local food environment and heart failure mortality. Heart failure is a chronic, progressive disease in which the heart muscle becomes so weak that it no longer pumps blood properly. According to Gondi, he and his colleagues studied heart failure death rates because it is a consistent metric reported across all US counties, allowing for a comprehensive assessment of heart failure outcomes at the population level. Heart failure accounted for more than 86,000 deaths in the U.S. in 2019, according to the Association Updated heart disease and stroke statistics for 2022.

The researchers sought to determine whether the dietary environment at the county level was associated with heart failure mortality. They looked at 2018 data from the National Vital Statistics System—a database of all births and deaths in the U.S.—and examined the relationship between each county’s heart failure death rate and the county’s 2018 food security percentile and Food Environment Index. .

The researchers compiled each county’s food insecurity percentage — the percentage of the population that does not have adequate regular access to healthy food — and a Food Environment Index score — an index ranked from 0 (worst) to 10 (best) based on a composite of indicators, including access to wholesome food , food insecurity, grocery store proximity, transportation, and socioeconomic factors – from the USDA Food Environment Atlas and the Robert Woods Johnson Foundation’s County Health Rankings. The Food Environment Atlas collects statistics on food environment indicators and provides a spatial overview of a community’s ability to access healthy food.

Estimated together, the food security percentage and the food environment index provide a clear picture of a population’s food environment.

Of the 2,956 counties in the study, the analysis showed:

• The average percentage of food security was 13% for all districts, and the average food environmental index score was 7.8.
• Counties with a food insecurity rate above the national average of 13.7% had higher rates of heart failure deaths compared to counties with a food insecurity rate below the average (30.7 deaths vs. 26.7 deaths per 100,000 people, respectively ).
• After adjusting for a number of socioeconomic and health factors, including poverty rates, income inequality, rural versus urban areas, type 2 diabetes, obesity, and smoking, a 1% decrease in food insecurity by county was associated with a 1% decrease .3% mortality from heart failure. Similarly, a 1-unit increase in the environmental food index by county was associated with a 3.6% reduction in heart failure mortality.
• At the county level, a decrease in the food environment index and an increase in the percentage of food insecurity were found to be more strongly associated with heart failure mortality than with mortality from other cardiovascular disease subtypes and all-cause mortality.
• The strongest association between dietary environment and heart failure mortality was found in countries with the highest income inequality and the highest levels of poverty.

“The results of this study are sad, but not surprising. These results are consistent with previous studies that have shown an association between cardiovascular disease and food insecurity,” said Ann Thorndike, MD, MPH, FAHA, director of the Lifestyle Cardiology Program at MIT, who was not involved in this study. Boston, former chairman of the Association’s Nutrition Committee and member of the Association’s Lifestyle Council. “This study provides a robust estimate of the food environment in US counties and shows that characteristics of the food environment are strongly associated with death from heart failure.”

A limitation of the study is that it only captures data for one year, before the COVID-19 pandemic, so it may have limited generalizability at this time. More research is needed to examine these associations over a longer period of time.

The study also found that counties with higher heart failure death rates also had fewer grocery stores, worse access to healthy food for adults over age 65, and lower participation in SNAP, the Supplemental Nutrition Assistance Program. SNAP is a U.S. government program that supplements food budgets to help reduce food insecurity for families and individuals with annual incomes at or below 130 percent of the federal poverty line (for a family of three, for those who has an annual income below $29,940, for SNAP).

According to the association Basic life 8, dietary intakeaffected by food insecurity is a major risk factor for cardiovascular disease, and the low prevalence of ideal diet accounts for the overall low prevalence of ideal cardiovascular disease in the US. Better cardiovascular health helps reduce risk heart diseases, stroke and other serious health problems.

“Food insecurity and lack of access to healthy food are key drivers of poor diet and what is called ‘nutrition’. uncertainty” Thorndike said. “The American Heart Association and others recognize that to help Americans achieve ideal cardiovascular health, especially an ideal diet, we need to expand our efforts to address both the psychological and social determinants of our behaviors in the field of health and wellness. These efforts should include policies, public health and community interventions that improve access to nutrients food for people at every stage of life.”

Co-authors are John Larson, MD; Aaron Sifuentes, MD; Neil B. Alexander, MD, MS; Matthew C. Connerman, MD; Kali S. Thomas, PhD, MA; and Scott L. Hummel, MD Author disclosures are listed in the manuscript.