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

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.