Emily Miller, Fred Croom, Tene Franklin Hamilton, Kimberly Glenn

Cardiac Deaths and Food Deserts

in Knox County, TN

This project is intended for the Office of Minority Health and Disparities Elimination in the Tennessee Department of Health as a product of a student internship. The work will be presented to East Tennessee State University as a sign of completing objectives defined by the College of Public Health for the required internship for the Master’s program and is a part of the student’s culminating experience.

Background

This study hopes to address the link between cardiac deaths and access to healthy foods for Knox County, TN

Introduction

DefinitionFor this study we used Death Statistical Systems

data from Vital Records in the Tennessee Department of Health

ICD-10 codes for myocardial infarction, heart failure, stroke, and coronary artery disease. The events were selected as being the Underlying Cause of Death, which includes codes: I21.0-I21.4, I21.9-122.1, I22.8-I23.6, I23.8; I11.0, I13.0, I42.0-I42.9, I50.0, I50.1, I50.9, I51.7; I60.0-I60.9, I61.0-I61.9, I63.0-I63.9, I64, I65.0-I65.9; I20.0, I20.8, I20.9, I21.0-I25.9 and I51.6.

Cardiac Deaths

Age-Adjustment

Since age is a risk factor associated with cardiac deaths it is important that we use age-adjusted rates in order to compare two populations

Cardiac Deaths

Data from the 2010 census was used for demarcating populations within Knox County

This was better than zip code data since these lines fall outside of county boundaries

Census Tract

Map of Census Tracts for Knox County

Census Data from 2010

was used for this report

Healthy Food Financing Initiative (HFFI)Low-income

Census tracts that meet the Treasury Department’s New Markets Tax Credit (NMTC)

Low AccessA “substantial” number of residence with low

access to a supermarket or large grocery store

HFFI – Food Desert

Map of Food Deserts for Knox County

Using the Healthy Food

Financing Initiative

(HFFI) criteria to define

the Census Tracts in

Knox County that are

considered a food

desert.

Quantile DistributionUsing the cardiac death rates found they

were then classified into 5 levels

Cardiac Deaths

Map of Cardiac Death Rates for Knox County

Age adjusted cardiac

death rates were

calculated using SAS for

each census tract. A

quantile distribution of

rates were used to

classify into 5 levels

Comparing Rates between Census TractsUsing ArcMap to export data to excel a two-tailed

t-test was used to assess the cardiac rates in census tracts considered to be food deserts and cardiac death rates in census tracts not considered to be a food desert

Cardiac Death Rates Compared to Food Deserts

Map of Cardiac Death Rates for Knox County

Cardiac Death Rates

compared between

census tracts considered

to be a food desert and

those that were not.

Comparing Rates between Census TractsT-test resulted in a p-value of 0.078252This shows significance with alpha= 0.10Therefore we have 90% confidence that there is a

significant difference between cardiac death rates for the food desert tracts compared to the non-food desert tracts

However, we are not 95% confident

Cardiac Death Rates Compared to Food Deserts

To gain understanding of healthy food access, the location of ‘healthy’ food retailers were obtained via communication with the Department of Agriculture

Healthy Food Retailer in Knox County

List of all Food Retailers for Knox County was provided by the Department of AgricultureFood Retailers included in the study based

upon definition of food retailers by the Department of Agriculture

Healthy Food Retailer in Knox County

Inclusion:23-Retail Fish Market-Deli43-Meat Market-Deli51-Market W Meat Dept & Deli52-Market W Meat Dept & Deli, 50 or more

seats81-Market82-Market W Food Service101-Retail Produce Market103-Retail Produce Market W Deli141-Health Food Store

Healthy Food Retailer in Knox County

Geocode AddressesThe list of food retailers include addresses

which were used to geocode their locations

Healthy Food Retailer in Knox County

Map of Healthy Food Retailers for Knox County

The stars on the map

depict the healthy food

locations designated by

the definition for type of

food retail they get from

the Department of

Agriculture

Map of Healthy Food Retailers for Knox County

One mile buffer was

assigned to each healthy

food retailer to better

understand the healthy

food distribution in Knox

County

Map of Cardiac Death Rates for Knox County

The healthy food

retailers were added to

the map in order to

understand their

relationship with

cardiac deaths and with

food deserts.

There is a significant difference in the rate of cardiac deaths for individuals living within a food desert compared to those living outside a food desert at the 90% confidence level.

Results

Difficulty in defining food deserts

Limitations

Because of the geographical nature of Knox county identifying food deserts can be difficult.Walkability improves access to retailersIncreased

Discussions

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References