Geospatial Analysis of Food Deserts and Their Impact on Health Outcomes in Children with Cystic Fibrosis

Abstract

Food insecurity (FI) is defined as “the limited or uncertain access to adequate food.” One root cause of FI is living in a food desert. FI rates among people with cystic fibrosis (CF) are higher than the general United States (US) population. There is limited data on the association between food deserts and CF health outcomes. We conducted a retrospective review of people with CF under 18 years of age at a single pediatric CF center from January to December 2019 using demographic information and CF health parameters. Using a Geographic Information System, we conducted a spatial overlay analysis at the census tract level using the 2015 Food Access Research Atlas to assess the association between food deserts and CF health outcomes. We used multivariate logistic regression analysis and adjusted for clinical covariates and demographic covariates, using the Child Opportunity Index (COI) to calculate odds ratios (OR) with confidence intervals (CI) for each health outcome. People with CF living in food deserts and the surrounding regions had lower body mass index/weight-for-length (OR 3.18, 95% CI: 1.01, 9.40, p ≤ 0.05 (food desert); OR 4.41, 95% CI: 1.60, 12.14, p ≤ 0.05 (600 ft buffer zone); OR 2.83, 95% CI: 1.18, 6.76, p ≤ 0.05 (1200 ft buffer zone)). Food deserts and their surrounding regions impact pediatric CF outcomes independent of COI. Providers should routinely screen for FI and proximity to food deserts. Interventions are essential to increase access to healthy and affordable food.

Transforming the nutrition care model for infants with cystic fibrosis: A qualitative study of clinicians' perspectives

“…24 Other studies have identified the significance of health impacts from social challenges such as food insecurity status and the economic implications of the COVID-19 pandemic for patients and families. 25,26 The current approaches shared by clinicians in this study provide insights on the importance of structure and guidance for clinicians to help support families. It also emphasizes the need for clinicians to actively adapt to address family needs.…”

“…A recent study involving family based experience surveys found families value collaborative care with their clinical teams, suggesting some congruence of family perspectives as found in our study of clinicians 24 . Other studies have identified the significance of health impacts from social challenges such as food insecurity status and the economic implications of the COVID‐19 pandemic for patients and families 25,26 . The current approaches shared by clinicians in this study provide insights on the importance of structure and guidance for clinicians to help support families.…”

Experiences and Perspectives of Individuals with Cystic Fibrosis and Their Families Related to Food Insecurity

“…Our results highlight important barriers to optimal adherence to CF dietary recommendations that can be exacerbated by FI, including cost of food, increased caloric requirements, single income household, transportation, and cost of housing, utilities, and healthcare. A recent study by our team showed that people with CF living in and near food deserts, a risk factor for FI, had increased odds of with a non-ideal lower BMI or weight-for-length [12]. It has also been noted that FI contributes to greater healthcare costs and financial strain, particularly when looking at patients with chronic disease [17].…”

“…As such, the CF Foundation (CFF) recommends an intake of at least 500 calories per day over the standard daily requirement with fat intake composing about 35-40% of those calories [6][7][8]. Given that people with CF have increased caloric demands, FI may contribute to the inability to achieve and maintain appropriate weight gain and lead to malnutrition in CF and is a nutritional risk factor for the CF population [9][10][11][12].…”