Food Insecurity Rose among US Adults with Cardiovascular Disease, According to National Study

The prevalence of food insecurity among persons with cardiovascular disease (CVD) increased significantly over approximately 2 decades in the US, according to new research published in JAMA Cardiology.

Specifically, investigators from Michigan Medicine found that 38% of individuals with CVD were food insecure between 2017 and 2018, more than double the number recorded 20 years earlier, when the rate of food insecurity was 16.3%.

“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 study author Eric J. Brandt, MD, MHS, cardiologist, University of Michigan Health Frankel Cardiovascular Center, in a press release.

To evaluate long-term prevalence of food insecurity among Americans with prior CVD or cardiometabolic risk factors, Brandt and colleagues conducted a serial cross-sectional study of 57 517 adults (mean age, 46 years; 52% women; 69% White) participating in the National Health and Nutrition Examination Survey from 1998 to 2018.

The team used the US Department of Agriculture Adult Food Security Survey Module to assess food insecurity and prevalence of food insecurity was estimated across racial and ethnic groups.

Among the total study cohort, 7.9% had CVD, 5.1% had coronary artery disease (CAD), 2.7% had stroke, 2.4% had heart failure, 49.6% had hypertension, 33.2% had obesity, 11.2% had diabetes, and 30.8% had dyslipidemia.

Food insecurity was reported by 11.8% of participants, and it was more prevalent among Hispanic (24%) and non-Hispanic Black (18.2%) adults than in non-Hispanic Asian (8.0%) and non-Hispanic White (8.5%) adults, according to the study results. In addition, all CVD and cardiometabolic diseases except CAD were more prevalent among adults with food insecurity compared to those without it.

Food insecurity higher among adults with CVD

The prevalence of food insecurity was higher among adults with CVD than those without, according to investigators. Among adults with CVD, the prevalence of food insecurity increased from 16.3% (95% CI, 13.5%-19.1%) in the 1999-2000 survey to 38.1% (95% CI, 31.1%-45.1%) in 2017-2018 (P <.001 for trend); however, the magnitude of change was not different from those without CVD (interaction coefficient=.02, P=.05 for interaction).

“We believe there is a two-way relationship here,” stated Brandt in the release. “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.”

The team also reported that between 2011 and 2018, the prevalence of food insecurity decreased among non-Hispanic Black adults (36.6%; 95% CI, 23.9%-49.4%, to 25.4%; 95% CI, 21.4%-29.3%; P=.04 for trend) but did not significantly change among other races and ethnicities.

“Increased recognition of food insecurity and resources to address it are needed to counter the negative consequences of food insecurity on cardiovascular disease outcomes,” concluded authors.