Adults with diabetes residing in "food swamps" have higher hospitalization rates

Abstract

Objective: To examine the relationship between food swamps and hospitalization rates among adults with diabetes.

Data sources: Blue Cross Blue Shield Association Community Health Management Hub^® 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010-2014.

Study design: Cross-sectional analysis of 784 counties across 15 states. Food swamps were measured using a ratio of fast food outlets to grocers. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Population-weighted models were controlled for comorbidities; Medicaid; emergency room utilization; percentage of population that is female, Black, Hispanic, and over age 65; and state fixed effects. Analyses were stratified by rural-urban category.

Principal findings: Adults with diabetes residing in more severe food swamps had higher hospitalization rates. In adjusted analyses, a one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all-cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care-sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all-cause hospitalization rate relationship was stronger in rural counties than urban counties.

Conclusions: Food swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity.

Keywords: diabetes; disparities; food swamps; hospitalizations; rurality.