Living in food deserts and adverse cardiovascular outcomes in patients with cardiovascular disease

Heval M. Kelli, Jeong Hwan Kim, Ayman Samman Tahhan, Chang Liu, Yi An Ko, Muhammad Hammadah, Samaah Sullivan, Pratik Sandesara, Ayman A. Alkhoder, Fahad K. Choudhary, M. Mazen Gafeer, Keyur Patel, Saqib Qadir, Tené T. Lewis, Viola Vaccarino, Laurence S. Sperling, Arshed A. Quyyumi

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Background—Food deserts (FDs), defined as low-income communities with limited access to healthy food, are a growing public health concern. We evaluated the impact of living in FDs on incident cardiovascular events. Methods and Results—We recruited 4944 subjects (age 64±12, 64% male) undergoing cardiac catheterization into the Emory Cardiovascular Biobank. Using the US Department of Agriculture definition of FD, we determined whether their residential addresses had (1) poor access to healthy food, (2) low income, or (3) both (=FD). Subjects were prospectively followed for a median of 3.2 years for myocardial infarction (MI) and death. Fine and Gray’s subdistribution hazard models for MI and Cox proportional hazard models for death/MI were used to examine the association between area characteristics (FD, poor access, and low income) and the rates of adverse events after adjusting for traditional risk factors. A total of 981 (20%) lived in FDs and had a higher adjusted risk of MI (subdistribution hazard ratio, 1.44 [95% CI, 1.06–1.95]) than those living in non-FDs. In a multivariate analysis including both food access and area income, only living in a low-income area was associated with a higher adjusted risk of MI (subdistribution hazard ratio, 1.40 [1.06–1.85]) and death/MI (hazard ratio, 1.18 [1.02–1.35]) while living in a poor-access area was not significantly associated with either (subdistribution hazard ratio, 1.05 [0.80–1.38] and hazard ratio, 0.99 [0.87–1.14], respectively). Conclusions—Living in an FD is associated with a higher risk of adverse cardiovascular events in those with coronary artery disease. Specifically, low area income of FDs, not poor access to food, was significantly associated with worse outcomes.

Original languageEnglish (US)
Article numbere010694
JournalJournal of the American Heart Association
Issue number4
StatePublished - 2019
Externally publishedYes


  • Cardiovascular disease
  • Death
  • Environment
  • Food desert
  • Myocardial infarction
  • Socioeconomic position

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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