Neighborhood Income Rather Than Food Access Is Associated With Adverse Cardiovascular Outcomes In Food Deserts

Introduction: Environmental characteristics and limited access to healthy food have been associated with cardiovascular risk factors. Food deserts, neighborhoods defined as both low income communities with limited access to healthy food, are a national concern. We evaluated the impact of living in food deserts on cardiovascular events and whether neighborhood income or food access is driving the health effect of food deserts. Hypothesis: Food deserts will be associated with cardiovascular outcomes. Methods: Subjects undergoing cardiac catheterization and recruited into the Emory Cardiovascular Biobank had their zip codes entered into the Food Deserts Atlas (U.S. Department of Agriculture) that specifies food deserts as combined low food access and low income areas. Cox proportional hazard models were used to analyze the association of these area characteristics with adverse events (all-cause mortality and myocardial infarction [MI]). Results: Of the 5240 patients (age 63±12, 64% male) enrolled, 1056 (24.1%) were living in low income areas, 1723 (32.9%) in low food access areas, and 1056 (20.2 %) in food deserts. During a median follow-up of 3.2 years, 988 (18.9%) patients died or developed a MI. After adjustment for cardiovascular risk factors and previous MI, patients living in food deserts had a higher risk of adverse events with hazard ratio (HR) of 1.28, (95% CI 1.04 - 1.58), p=0.018 (Figure). However, when compared to subjects in high income and good food access areas, those with high income and low access had similar outcomes HR 0.99 (CI 0.82-1.20). Moreover, even people within low income neighborhoods with good food access had similar outcomes to those in food deserts HR 0.96 (CI 0.78-1.16). Conclusions: Although living in food deserts is associated with a higher risk of death and MI, its impact is mainly due to area income rather than food access. Whether this is due to nutritional status or lifestyle of people living in these areas needs to be further evaluated.