Abstract Body (Do not enter title and authors here): Background:
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. While healthy dietary habits are known to reduce morbidity and mortality, the impact of neighborhood-level healthy food mobility behaviors on mortality in patients with established ASCVD is not well understood.
Objective:
To evaluate the association between census tract-level healthy food mobility patterns and all-cause mortality among U.S. Veterans with established ASCVD.
Design:
Retrospective observational cohort study of 770,990 U.S. Veterans (2016–2021) with stable ASCVD—including coronary artery disease (CAD), cerebrovascular disease (CeVD), or peripheral artery disease (PAD)—with a median follow-up of 4.33 years (maximum: 6.33 years). ASCVD was identified using ICD-10 codes. Neighborhood mobility data, obtained from SafeGraph, were linked to Veterans' residential census tracts. The Retail Food Activity Index (RFAI), defined as the proportion of visits to healthy food venues relative to total food-related visits, was used to measure nutrition-related mobility behavior. RFAI was calculated using 2019 origin-destination mobility data from Dewey’s Advanced Research Monthly Patterns datasets, derived from approximately 10% of U.S. GPS-enabled mobile devices.
Main Outcomes and Measures:
Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Associations between RFAI and all-cause mortality were assessed using Cox proportional hazards models. Competing risk Fine-Gray models were used to evaluate associations with MACE with non-CV mortality as the competitive risk event.
Results:
Among 770,990 Veterans (mean age 71.7 years; 98% male), higher RFAI was significantly associated with reduced all-cause mortality (HR = 0.5567, p < 0.001) after adjusting for clinical and social covariates, as well as neighborhood-level mobility indicators (average time in greenspaces and recreation facilities). Higher RFAI was also associated with reduced MACE risk (subHR = 0.6287, p < 0.001).
Conclusions and Relevance:
In this nationwide cohort of U.S. Veterans with stable ASCVD, healthier neighborhood-level food mobility behaviors were associated with significantly lower all-cause mortality and MACE. These findings highlight the potential of improving local access to healthy food as a population-level strategy to enhance cardiovascular outcomes and longevity in vulnerable populations.