Scope and social determinants of food insecurity among adults with atherosclerotic cardiovascular disease in the United States

Shiwani Mahajan, Gowtham R. Grandhi, Javier Valero-Elizondo, Reed Mszar, Rohan Khera, Isaac Acquah, Tamer Yahya, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Miguel Cainzos-Achirica, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) results in high out-of-pocket healthcare expenditures predis-posing to food insecurity. However, the burden and determinants of food insecurity in this population are unknown. METHODS AND RESULTS: Using 2013 to 2018 National Health Interview Survey data, we evaluated the prevalence and so-ciodemographic determinants of food insecurity among adults with ASCVD in the United States. ASCVD was defined as self-reported diagnosis of coronary heart disease or stroke. Food security was measured using the 10-item US Adult Food Security Survey Module. Of the 190 113 study participants aged 18 years or older, 18 442 (adjusted prevalence 8.2%) had ASCVD, representing ≈20 million US adults annually. Among adults with ASCVD, 2968 or 14.6% (weighted ≈2.9 million US adults annually) reported food insecurity compared with 9.1% among those without ASCVD (P<0.001). Individuals with ASCVD who were younger (odds ratio [OR], 4.0 [95% CI, 2.8–5.8]), women (OR, 1.2 [1.0–1.3]), non-Hispanic Black (OR, 2.3 [1.9–2.8]), or Hispanic (OR, 1.6 [1.2–2.0]), had private (OR, 1.8 [1.4–2.3]) or no insurance (OR, 2.3 [1.7–3.1]), were divorced/widowed/sepa-rated (OR, 1.2 [1.0–1.4]), and had low family income (OR, 4.7 [4.0–5.6]) were more likely to be food insecure. Among those with ASCVD and 6 of these high-risk characteristics, 53.7% reported food insecurity and they had 36-times (OR, 36.2 [22.6–57.9]) higher odds of being food insecure compared with those with ≤1 high-risk characteristic. CONCLUSION: About 1 in 7 US adults with ASCVD experience food insecurity, with more than 1 in 2 adults reporting food insecurity among the most vulnerable sociodemographic subgroups. There is an urgent need to address the barriers related to food security in this population.

Original languageEnglish (US)
Article numbere020028
JournalJournal of the American Heart Association
Issue number16
StatePublished - Aug 17 2021


  • Atherosclerotic cardiovascular disease
  • Disparities
  • Food insecurity
  • Social determinants of health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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