Food Swamps and Food Deserts Impact on Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality in US Counties.

BACKGROUND AND AIMS: Lacking access to quality food may increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). We investigated associations between food environment factors (food deserts and food swamps) and MASLD-related mortality across the United States.

METHODS

MASLD-related deaths were obtained from the National Vital Statistics System (2016-2020) and food environment factors from Food Environment Atlas. Food deserts are areas where low-income residents have limited access to affordable and nutritious food due to a scarcity of nearby grocery stores. Food swamps are areas oversaturated with outlets offering limited healthy food options.

RESULTS

Counties in the highest mortality quartile (fourth quartile) compared with the lowest mortality quartile (first quartile) were predominantly located in the South region (78.7% vs 23.5%) and rural areas (76.1% vs 26.6%). These counties also had higher rates of elderly residents (19.4% vs 16.5%), Hispanic residents (13.1% vs 10.5%), household crowding (2.83% vs 2.37%), no broadband Internet subscription (23.9% vs 12.7%), no high school diploma (16.1% vs 9.0%), poverty (30.2% vs 18.5%), unemployment (6.4% vs 4.7%), food deserts (8.7% vs 5.8%), and food swamp ratio (5.69 vs 4.28) (all P values <.001). After adjusting for county sociodemographic and clinical factors and regions, mixed-effects linear regression models showed significant differences in mortality rates (per 100,000) between counties with the highest vs lowest quartiles of food deserts (25.65 vs 12.75, adjusted difference = 3.66 [95% confidence interval, 2.66-4.72]) and food swamps (27.13 vs 20.15 per 100,000, adjusted difference = 3.57 [95% confidence interval, 2.44-4.71]).

CONCLUSIONS

In the United States, addressing sociodemographic and food environment disparities is paramount to reduce MASLD-related mortality.