Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients With Cardiovascular Disease
Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients With Cardiovascular Disease
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DOI：
10.1161/jaha.118.010694
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发表时间：
2019-02-19
影响因子：
5.4
通讯作者：
Quyyumi, Arshed A.
中科院分区：
文献类型：
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作者：
Kelli, Heval M.;Kim, Jeong Hwan;Quyyumi, Arshed A.
背景-食品沙漠(FDs)是指获得健康食品的机会有限的低收入社区，是一个日益严重的公共卫生问题。方法和结果：我们招募了4944名接受心导管置入术的受试者(年龄+/-12岁，%，男性)进入Emory心血管生物库。使用美国农业部对FD的定义，我们确定了他们的居住地址是否(1)难以获得健康食品，(2)低收入，或(3)两者都有(=FD)。受试者因心肌梗死(MI)和死亡接受前瞻性追踪，中位数为3.2年。MI的Fine和Gray的次分布风险模型和死亡/MI的Cox比例风险模型被用来检验地区特征(FD、可获得性差和低收入)与调整传统危险因素后不良事件发生率之间的关系。共有981人(20%)生活在疾病控制中心，其MI的调整风险(再分布危险比，1.44[95%可信区间，1.06-1.95])高于非疾病控制中心的患者。在包括食物获取和地区收入的多变量分析中，仅生活在低收入地区与较高的调整后MI风险(次分布危险比，1.40[1.06-1.85])和死亡/MI(危险比，1.18[1.02-1.35])相关，而生活在较差地区与两者均无显著关联(次分布危险比，1.05[0.80-1.38]和危险比，0.99[0.87-1.14]，结论：在冠心病患者中，居住在FD中的患者发生不良心血管事件的风险更高。具体地说，发展中国家的地区收入低，而不是获得食物的机会少，与更糟糕的结果显著相关。
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.