Impact of Food Insecurity on Outcomes following Coronary Artery Bypass Grafting

L. Azap¹, S. Woldesenbet¹, M. C. Henn², B. A. Whitson², J. Bozinovski³, N. A. Mokadam², A. M. Ganapathi¹, T. Pawlik^1
1The Ohio State University, Columbus, Ohio ²The Ohio State University Wexner Medical Center, Columbus, Ohio ³OSU, Columbus, Ohio

Purpose: Food insecurity (FI) predisposes individuals to substandard nutrition and socioeconomic hardship, which may lead to advanced cardiovascular disease as well as delays in care. The impact of nutritional disparities on cardiac surgical outcomes remains ill-defined. We sought to characterize the association between county-level FI and post-operative outcomes within cardiac surgery.

Methods: Patients who underwent coronary artery bypass grafting (CABG) between 2016-2020 were identified utilizing the Medicare Standard Analytic Files. County-level FI rates from 2015 were acquired from Feeding America: Mapping the Meal Gap report. Patients were stratified into low ( < 10th percentile), moderate (10-90th percentile) and high (>90th percentile) cohorts based on FI level during the study. The social vulnerability index (SVI) is a scale using census tract information to identify areas of deprivation, where lower scores denote low vulnerability and higher scores denotes increased vulnerability. Optimal textbook outcomes (TO) were defined as the absence of post-operative complications, 90-day mortality, 90-day readmissions, and extended length of stay (LOS). Extended LOS was defined as hospital stay greater than the 75th percentile. Multiple logistic regression and Cox regression models that adjusted for patient and hospital-level covariates were utilized to evaluate outcomes and survival relative to FI.

Results: Among 267,914 patients who underwent CABG, 26,835 patients lived in low FI counties, 214,601 lived in moderate FI counties, and 26,478 lived in high FI counties. High FI patients were predominately Non-Hispanic Black (low: 651, 2.4% vs. high: 2,859, 10.8%), resided in areas of high social vulnerability (low: 1,652, 6.2% vs. high: 23,824, 90.0%), as well as received care at low volume hospitals (low: 7,024, 26.2% vs. high: 11,213, 42.3%) (all p< 0.0001). Patients who resided in high FI counties had greater odds 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, patients who resided within high FI counties were less likely to achieve optimal TO (OR: 0.94, 95% CI: 0.90-0.99) in comparison to patients in low FI counties. Patients residing in high FI counties were also at greater risk of 1-year (HR: 1.19, 95% CI: 1.12-1.27), 3-year (HR: 1.14, 95% CI: 1.09-1.20), and 5-year mortality (HR: 1.11, 95% CI: 1.06-1.17) (all p< 0.0001). Interestingly, Black patients who lived in high FI areas had a greater risk of 5-year mortality versus White patients who also resided within high FI counties (HR: 1.27, 95% CI: 1.17-1.38, p< 0.0001).

Conclusion: County-level FI was associated with higher odds of suboptimal post-operative outcomes and survival among patients undergoing CABG. Racial disparities persisted within varying degrees of FI, suggesting inequitable access to healthcare. Interventions aimed at mitigating nutritional inequities are essential to improve outcomes among vulnerable patients undergoing cardiac surgery.

Identify the source of the funding for this research project: There is no source of funding for this research project.