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Health Serv Res. 2019 Feb;54 Suppl 1:217-225. doi: 10.1111/1475-6773.13102. Epub 2019 Jan 6.

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

Author information

1
University of California Berkeley, Berkeley, California.
2
Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, California.

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

PMID:
30613953
PMCID:
PMC6341203
[Available on 2020-02-01]
DOI:
10.1111/1475-6773.13102

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