Adults with diabetes residing in “food swamps” have higher hospitalization rates

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.