Food Insecurity in the US Increasing, More Prevalent in those with Cardiovascular Disease

Eric Brandt, MD, MHS

An analysis of nutrition survey data from more than 55,000 US adults paints a grim picture related to food insecurity among individuals with cardiovascular disease or cardiometabolic risk factors.

Results of the analysis, which included data from a 20-year period, suggests the prevalence of food insecurity has increased over time among the overall population, with the frequency among people with cardiovascular disease also increasing.

“Food insecurity is a common problem among people with cardiovascular disease, and we are seeing that issue become even more prevalent in recent years,” said lead investigator Eric J. Brandt, MD, MHS, a cardiologist at the University of Michigan Health (U-M Health) Frankel Cardiovascular Center, in a statement. “We believe there is a two-way relationship here. Individuals who are food insecure may have increased risk for cardiovascular disease, and vice versa. When one acquires heart disease, it impacts one’s risk for developing socioeconomic problems that could reduce access to adequate and quality food. Food insecurity can often occur with other social determinants of health, such as poor transportation access or access to healthcare, which further compounds this relationship.”

As more research has elucidated the impact of social determinants of health on outcomes, particularly among people with cardiovascular disease, the focus on food insecurity and its impact on health has grown as well. Together with a team of colleagues from U-M Health, Brandt sought to assess how the long-term prevalence of food insecurity has changed among people in the US, with a particular interest in those with cardiovascular disease and cardiometabolic risk factors.

To do so, the team designed a serial cross-sectional study leveraging data from US adults who participated within the National Health and Nutrition Examination Survey during cycles from 1999-2018. Investigators noted food insecurity was assessed using the US department of Agriculture Adult Food Security Survey Module. Investigators also noted prior cardiovascular disease was defined as myocardial infarction, stroke, or heart failure and cardiometabolic risk factors were defined as hypertension, diabetes, obesity, and hyperlipidemia. For the purpose of analysis, investigators planned to estimate the prevalence of food insecurity among those with cardiovascular disease and cardiometabolic risk factors across racial and ethnic groups and prevalence of Supplemental Nutrition Assistance Program (SNAP) participation among those reporting food insecurity.

Overall, an analytic sample of 57,517 US adults, which investigators noted was representative of 312 million, was identified for inclusion in the investigators’ analyses. The sample was s 1.6% Asian, 11.2% Black, 13.8% Hispanic, 68.8% White, and 4.6% other or multiracial. Initial analysis indicated food insecurity was present among 11.8%, but increased throughout the study period. Initial analysis also revealed 7.0% of adults participated in SNAP and any cardiovascular disease was present among 7.9%. When assessing prevalence of cardiometabolic risk factors 49.6% had hypertension, 33.2% had obesity, 11.2% had diabetes, and 30.8% had dyslipidemia.

Further analysis demonstrated food insecurity was more prevalent among Hispanic (24.0%) and non-Hispanic Black (18.2%) individuals than non-Hispanic Asian (8.0%) and non-Hispanic White individuals (8.5%). Food insecurity increased over time and was more frequent among patients with cardiovascular disease, but this was not observed among those with cardiometabolic risk factors. Investigators pointed out non-Hispanic Black individuals with cardiovascular disease experienced a decrease in food insecurity prevalence from 2011-2018 (36.6% [95% CI, 23.9-49.4] vs 25.4% [95% CI, 21.4-29.3]; P= .04 for trend), but increases were observed for individuals of other races and ethnicities. Investigators also pointed out, for individuals with food insecurity, SNAP participation was greater among those with cardiovascular disease than those without cardiovascular disease (54.2% [95% CI, 46.6-61.8] vs 44.3% [95% CI, 40.5-48.1]; P=.01).

“Healthcare providers can impact the health and overall wellbeing of their patients by addressing food insecurity,” said study investigator Tammy Chang, MD, MPH, MS, a family physician at U-M Health and codirector of the National Clinician Scholars Program at the U-M Institute for Healthcare Policy and Innovation, in the aforementioned statement. “More patients than you may think are impacted by food insecurity. A team-based approach including social workers, case managers and social service departments can help patients get connected with local resources. If we are serious about promoting health, healthcare providers need to ensure people have access to healthy foods and don’t go hungry.”

This study, “Food Insecurity Among Individuals With Cardiovascular Disease and Cardiometabolic Risk Factors Across Race and Ethnicity in 1999-2018,” was published in JAMA Cardiology.