Online Program

Cardiovascular Disease and Access to Healthy Food among Highland Hospital Patients

Tuesday, November 3, 2015

Miranda Weintraub, PhD, MPH, Public Health Program, Touro University, Berkeley, CA
Elizabeth Kelley, MPH, Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Oakland, CA
Matthew Bozdech, BA, MPH student, Public Health Program, Touro University California, El Cerrito, CA
Irene Yen, PhD, MPH, Medicine, Highland Hospital, Alameda Health System, San Francisco, CA
Background:  Cardiovascular diseases (CVD) are the leading cause of death in Alameda County (AC).  The association between socioeconomic characteristics and CVD can be partially explained by neighborhood factors, such has healthful food access. Highland Hospital (HH), in Oakland, CA, is a safety-net hospital serving low-income residents of AC. This study assessed the association between the modified retail food environment index (mRFEI) and the proportion of HH patients with CVD.

Methods: All patients seen at HH between July 1, 2013 and June 30, 2014 who lived in AC and for whom a geocoded address match was available (n=39,533) were included. Data was matched with US Census data and the USDA’s mRFEI, representing the percentage of retailers within a 0.5 mile buffer of a given census tract that are more likely to sell healthful food. CVD diagnosis was based on ICD-9 codes.  Census tracts were divided into the top and bottom two quartiles with the largest and smallest proportion of patients with a CVD diagnosis. Bivariate analyses examined the association between tracts with the highest and lowest proportions of CVD diagnosed patients and patient demographics (age, race/ethnicity, and sex) and the mRFEI.  Logistic regressions modeled the CVD-mRFEI association, controlling for covariates. 

Results:Tracts with higher proportions of CVD-diagnosed patients were more likely to have lower mRFEI scores (mean=7.80; SD=6.21 vs. mean=8.68; SD=5.98, p<0.001).  This association persisted after controlling for covariates (OR=0.99; 95% CI: 0.98 - 0.99).

Conclusions:  AC tracts with the highest versus lower proportion of patients with CVD have fewer healthful retail food outlets, providing evidence of the CVD-food environment link. Neighborhoods with a higher proportion of patients with CVD may be a due to limited access to healthful food.  Public health programs focused on health promotion and CVD prevention should consider the accessibility of healthful food options within low-income communities.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Assess the association between the census-tract retail food environment and the proportion of resident patients with a cardiovascular-related illness.

Keyword(s): Heart Disease, Public Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Miranda Ritterman Weintraub, PhD, is Professor in the Public Health Program at Touro University California and the Research Coordinator at Highland Hospital's Department of Medicine in Oakland, CA. She is experienced in epidemiological studies on the social gradient. Over the last decade she has worked extensively on research locally, nationally and abroad, investigating the link between social and environmental factors and health-related outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.