Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000-2020

Importance Food insecurity is associated with prevalent cardiovascular disease (CVD), but studies have been limited to cross-sectional data. Objectives To study whether food insecurity is associated with incident CVD and to determine whether this association varies by sex, education, or race. Design, Setting, and Participants This prospective cohort study was conducted among US adults without preexisting CVD participating in the CARDIA (Coronary Artery Risk Development in Young Adults) study from 2000 to August 31, 2020. Data analysis was conducted from December 2022 to April 2024. Exposure Food insecurity, defined as endorsing limitations in household food variety and/or food quantity, assessed in the period 2000-2001. Main Outcomes and Measures The primary outcome was CVD events, consisting of fatal and nonfatal coronary heart disease, heart failure, stroke, transient ischemic attack, or peripheral arterial disease, identified annually through August 31, 2020. Results Of 3616 total participating adults, mean (SD) age was 40.1 (3.6) years, and 2027 participants (56%) were female. Of 3616 participants, 1696 (47%) self-reported Black race and 529 participants (15%) had food insecurity at baseline. Individuals with food insecurity were more likely to self-identify as Black and report lower educational attainment. The mean (SD) follow-up period was 18.8 (3.4) years, during which 255 CVD events occurred: 57 events (11%) in food-insecure participants and 198 events (6%) in food-secure participants over the study period. After adjusting for age, sex, and field center, food insecurity was associated with incident CVD (adjusted hazard ratio [aHR], 1.90; 95% CI, 1.41-2.56). The association persisted (aHR, 1.47; 95% CI, 1.08-2.01) after further adjustment for the socioeconomic factors of education, marital status, and usual source of medical care. Conclusions and Relevance In this prospective cohort study among participants in the CARDIA study, food insecurity was associated with incident CVD even after adjustment for socioeconomic factors, suggesting that food insecurity may be an important social deprivation measure in clinical assessment of CVD risk. Whether interventions to reduce food insecurity programs can potentially alleviate CVD should be further studied.