Food Insecurity and Cardiovascular Mortality for Nonelderly Adults in the United States From 2011 to 2017

Food Insecurity and Cardiovascular Disease Risk

“…Eleven studies used a nationally representative sample [27, 29, 30••, 32, 33, 35-40], while three studies used convenience samples [28,31] or state-specific representative samples [34]. Twelve studies were cross-sectional [28, 29, 30••, 31-39], and one study was ecological [40], whereas one used longitudinal analysis [27]. Four studies focused on evaluating the relationship between food insecurity and CVD outcomes among low-income populations that fell below a certain percentage of the federal poverty level [27, 30••, 31, 36].…”

“…The other seven studies used binary comparisons of adults living in food insecure households with those living in FS households [27,28,31,33,34,37,40]. Overall, food insecurity was associated with significantly decreased likelihood of good self-reported cardiovascular health (OR = 0.53, 95% CI 0.31-0.92) [34], higher odds of reporting CVD-related outcomes such as peripheral arterial disease (OR = 1.50, 95% CI 1.11-2.03) [33] and heart disease (OR = 2.65, 95% CI 1.05-6.69) [31], and higher mortality rate among individuals with cardiorenal syndrome (HR = 2.81, 95% CI 1.57-5.05) [27].…”

“…Overall, food insecurity was associated with significantly decreased likelihood of good self-reported cardiovascular health (OR = 0.53, 95% CI 0.31-0.92) [34], higher odds of reporting CVD-related outcomes such as peripheral arterial disease (OR = 1.50, 95% CI 1.11-2.03) [33] and heart disease (OR = 2.65, 95% CI 1.05-6.69) [31], and higher mortality rate among individuals with cardiorenal syndrome (HR = 2.81, 95% CI 1.57-5.05) [27]. The ecological study using county-level longitudinal analysis of data from 3142 US counties across 50 states and Washington DC (2011-2017) showed that a 1% point increase in food insecurity was associated with a 0.83% (95% CI 0.43-1.25%, p < 0.001) increase in age-adjusted cardiovascular mortality [40]. Surprisingly, one study using data from a convenience sample of 2066 US adults aged 30-64 years showed that living in FS households was associated with higher 10-year CVD risk (p < 0.001) relative to food insecure households, though the study used a single item question to assess food security status and thus may be subjected to misclassification bias [28].…”

Food insecurity and cardiovascular disease: Current trends and future directions

“…FI is also associated with higher likelihood of cardiovascular mortality. An analysis of data from more than three thousand US counties estimated that an increase in a county's FI rate corresponded with an increase in the county's age-adjusted cardiovascular mortality rate [ 28 ]. Another survey of 27,188 US adults found that increasing severity of FI was associated with increased risk of cardiovascular and all-cause mortality, with participants experiencing very low food security having a 1.53-fold increased risk of cardiovascular mortality, compared to food-secure participants [ 29 ].…”

“…This is particularly relevant for evaluating risk factors – such as whether food-insecure women are at greater risk of developing dyslipidemia than their male counterparts – and establishing a stronger causal relationship between FI and CVD [ 42 ]. Furthermore, there is some inconsistency in how FI is measured across studies; while most studies use the USDA or Hunger Vital Sign surveys, some rely on estimates from nonprofit food aid organizations or other surveying methods [ 27 , 28 ]. Future studies should use the validated USDA 18-item FI screening tool or the 2-item Hunger Vital Sign survey to allow comparability of findings across study designs and target populations.…”