Associations of food security and food assistance with cardiovascular morbidity and mortality among postmenopausal women from the women’s health initiative

BACKGROUND: Prior research indicates that food insecurity is negatively associated with cardiometabolic health and plays a role in cardiovascular disease (CVD) risk, which also increases with age. Food insecurity disproportionately affects ageing women in the USA, who face higher poverty and economic insecurity rates than their male counterparts, increasing their risk for hunger, poor nutrition and chronic conditions. We examined the association of food security and assistance with CVD morbidity and mortality risks in postmenopausal women through a target trial emulation. METHODS: A retrospective cohort study was conducted among 41 227 postmenopausal women from the Women's Health Initiative Observational Study free of CVD at baseline. Approximately 96% reported food security and 3% reported reliance on food assistance at 6 years of follow-up (analytical baseline). Furthermore, 16% of 1861 women reporting food insecurity also reported food assistance. Inverse probability of treatment weighting (IPTW) within Cox regression models was performed using demographic, socioeconomic, lifestyle and health characteristics collected prior to the analytical baseline. RESULTS: Overall, 6037 eligible women experienced CVD outcomes over ~24 years of follow-up. In IPTW Cox regression models, food security (HR=0.65, 95% CI 0.47 to 0.89) and food assistance (HR=0.47, 95% CI 0.46 to 0.48) were inversely related to CVD risk. Similar results were obtained for all-cause and chronic disease-specific mortality risks. CONCLUSION: Food security and assistance are generally associated with lower CVD risks after menopause, with implications for food assistance programmes, targeted nutritional counselling, community interventions and holistic care among ageing women in the USA.