This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

Increases in food insecurity were found to be independently associated with increased cardiovascular (CV) mortality rates in nonelderly adults, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.1

Investigators determined rates of county-level CV death and food insecurity among adults ages 20 to 64 and ≥65 years in the United States based on data from the National Center for Health Statistics and the Map the Meal Gap study, respectively, for the 2011 to 2017 period. CV mortality trends were examined by quartiles of average annual percent change (APC) in food insecurity, which was defined as a lack of immediate access to fresh, healthy, and affordable food. The association between longitudinal changes in food insecurity and CV mortality rates was assessed after accounting for time-varying demographic, economic, and healthcare access variables.

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Mean food insecurity rates were found to decrease from 14.7% to 13.3% between 2011 and 2017. In counties in the highest quartile of APC for absolute value change in food insecurity, the nonelderly CV mortality rate increased from 82.2±33.9 per 100,000 persons to 87.4±37.3 per 100,000 persons (P < .001). In counties in the lowest quartile of APC, the mortality rate was stable (2011: 60.8±22.2 per 100,000 persons; 2017: 60.0±23.0 per 100,000 persons; P = 64).

The CV mortality rate in the elderly group declined significantly in all quartiles: from 1643.3±315.7 per 100,000 persons in 2011 to 1542.7±299.4 per 100,000 persons in 2017 in the highest quartile (P <.001), and from 1408.3±225.9 per 100,000 persons in 2011 to 1338.6±213.8 per 100,000 persons in 2017 in the lowest quartile (P <.001). A 1% point increase in food insecurity was independently associated with a 0.83% increase in CV mortality among nonelderly adults (95% CI, 0.42-1.25; P <.001), but not among elderly adults (difference, -0.06%; 95% CI, -0.39 to 0.28; P =.74).

“This research shows food insecurity, which is a particular type of economic distress, is associated with cardiovascular disease,” noted study co-author Sameed Khatana, MD, MPH, instructor of cardiovascular medicine at the Perelman School of Medicine, University of Pennsylvania in Philadelphia.2 “It illustrates that cardiovascular health is tied to many things. It’s more than doctors’ visits, screenings, medications, and procedures. What is going on outside the clinic, in society, has a significant impact on patients’ health, too.”


  1. Wang SY, Venkataramani AS, Roberto CA, et al. Food insecurity linked to higher risk of cardiovascular death. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation 239.
  2. Food insecurity linked to higher risk of cardiovascular death [press release]. Dallas, Texas: American Heart Association; November 9, 2020.

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