County-level food insecurity is associated with outcomes following cardiac surgery

Abstract

Background

As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery.

Methods

In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of “optimal” post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival.

Results

Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 ​% CI: 0.90–0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 ​% CI: 1.12–1.36) and extended LOS (OR: 1.07, 95 ​% CI: 1.01–1.14) (all p ​< ​0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 ​% CI: 1.06–1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 ​% CI: 1.17–1.38, p ​< ​0.0001) compared with White patients within the same FI level.

Conclusions

County-level FI was associated with worse outcomes following cardiac surgery.