Abstract WE430: Food Insecurity and Cardiovascular Disease Among U.S. Adults with Diabetes: Moderation by SNAP

Abstract

Background: Food insecurity (FI) is a major social determinant of health and disproportionately affects individuals with diabetes, potentially increasing their risk for cardiovascular disease (CVD). Participation in food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) may buffer this relationship by improving food access, yet national evidence remains limited. We aimed to examine the association between FI and CVD among adults with diabetes in the U.S., and the possible modifying role of SNAP participation. Methods: We conducted a cross-sectional analysis of data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) for 31,313 adults aged ≥18 years who self-reported a diabetes diagnosis. FI was assessed with a single question about whether food ran out in the last 12 months due to financial constraints. Outcomes included self-reported coronary heart disease (CHD), myocardial infarction (MI), stroke, and a composite of the three. Weighted multivariable logistic regression to determine the association between FI and CHD, MI and stroke adjusted for sociodemographic and behavioral covariates. Results: Approximately 18.4% of adults with diabetes reported FI, 15.1% participated in SNAP, 12.5% had CHD, 12.2% had MI, 8.8% had a stroke, and 23.8% had at least one condition of the CVD composite. Individuals experiencing FI had significantly higher odds of CVD composite (adjusted odds ratio 1.39, 95% CI: 1.16-1.66) compared to those with food security. Specifically, FI was associated with higher adjusted odds of CHD (1.48, 1.17-1.87), MI (1.33, 1.05-1.68) and stroke (1.29, 1.03-1.63). SNAP participation did not modify the associations between FI and CVD (all p>0.05). Conclusions: Our findings reveal that FI is associated with CVD among adults with diabetes. If replicated in longitudinal studies, these results would provide arguments for incorporating routine FI screening into clinical settings to identify and offer additional support to high-risk individuals.