Link Between Health of Local Food Environment and County-Level HF Mortality

In the United States, county-level heart failure mortality rates are affected by the health of the local food environment.

A significant association has been observed between the health of the local food environment and rates of county-level mortality from heart failure (HF), according to the results of a cross-sectional analysis of data obtained from the National Vital Statistics System and the US Department of Agriculture Food Environment Atlas. Findings from the study were published in the journal Circulation: Heart Failure.

Recognizing that food environment factors contribute to cardiovascular disease, the researchers sought to evaluate their effect on population HF mortality rates. Data from the 2 publicly available databases indicated above, along with 2 county food environment (FE) indices—food insecurity percentage (FI%) and food environment index (FEI)—were used.

FI% was defined as the percentage of the population who did not have access to a reliable source of food during the past year. FEI was a scaled index from 0 (the worst) to 10 (the best), which was defined as a comprehensive metric of whether a locality is a food desert, encompassing multiple metrics of the food environment, including food access, food security, proximity to stores, income, and local  geographic and socioeconomic factors.

Results of the study showed that the mean county FI% and FEI were 13% and 7.8%, respectively, among a total of 2956 included counties from the United States. Those counties with an FI% above the national median (≥13.7%) exhibited significantly higher HF mortality rates than did those with an FI% below the national median (<13.7%; 30.7% vs 26.7%, respectively, per 100,000 individuals; P <.001).

These findings reinforce the role of food environment and socioeconomic deprivation on cardiovascular outcomes.

Further, counties with an HF mortality rate that was above the national median reported significantly higher FI%, lower FEI, poorer access to stores among older adults, lower density of grocery stores, and lower participation rates in the Supplemental Nutrition Assistance Program (P <.001, for all).

After adjustment for county demographic, socioeconomic, and health factors, lower county FI% (β= -1.3% per 1% decrease) and higher county FEI (β= -3.6% per 1-unit increase in FEI) both were associated with significantly lower HF mortality rates. This association was stronger for HF mortality rates, compared with nonHF cardiovascular disease mortality rates and all-cause mortality rates.

The link between the food environment and the HF mortality rates was stronger in those counties that reported the highest income inequity and poverty rates.

Several limitations of the analysis include the use of observational data that were cross-matched from multiple datasets, which allows for potential bias related to the data sources. Additionally, this study is limited by its utilization of crude mortality rates, with differences in mortality rates potentially driven by differential age distributions in certain counties.

 “These findings reinforce the role of food environment and socioeconomic deprivation on cardiovascular outcomes,” the study authors wrote.

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


Gondi KT, Larson J, Sifuentes A, et al. Health of the food environment is associated with heart failure mortality in the United States. Circ Heart Fail. Published online October 25, 2022. doi:10.1161/CIRCHEARTFAILURE.122.009651