Importance: Food insecurity is associated with worse cardiovascular health. There is variation in state Supplemental Nutrition Assistance Program (SNAP) eligibility and administration policies that influence participation rates, but how such policies impact cardiovascular mortality is not known. Objective: To evaluate the association of SNAP-related policies with county-level cardiovascular mortality rates. Design, Setting, and Participants: In this cross-sectional study, using state-level SNAP policy data from the US Department of Agriculture, a SNAP policy index was created (range, 0-10), with higher values denoting adoption of policies associated with higher SNAP participation. Mortality data from the National Center for Health Statistics and population data from the Census Bureau were used to calculate county-level, age-adjusted, cardiovascular mortality rates for adults aged 20 years and older. Exposures: Changes in an index of state SNAP policies from 2006 to 2019. Main Outcomes and Measures: The primary outcome was county-level cardiovascular mortality rates. Using the g-computation procedure, a robust causal inference method, and a marginal structural model, the association between changes in the SNAP policy index and county-level cardiovascular mortality rates was estimated. Mortality rates were also estimated under different potential trajectories for the SNAP index. Results: Between 2006 and 2019, there were a total of 11 409 251 cardiovascular deaths among adults in 3127 US counties (5 713 305 deaths 50.1% occurred among women; 9 266 123 deaths 81.2% among adults aged ≥65 years). The median (IQR) SNAP policy index value increased from 3.7 (2.7-4.2) to 7.1 (5.6-7.5). After accounting for differences in demographic and economic factors, a 1-point absolute increase in the SNAP policy index was associated with a 1.02% (95% CI, 0.47%-1.60%; P < .001) lower county cardiovascular mortality rate. If all states had followed a high-generosity SNAP policy trajectory, compared with if they had followed a low-generosity trajectory, an estimated 46 123 (95% CI, 28 587-65 096) fewer adult cardiovascular deaths are estimated to have occurred in 2019. Conclusions and Relevance: In this cross-sectional study of SNAP policies and cardiovascular mortality, an index of policies that can increase SNAP participation was associated with statistically significantly lower cardiovascular mortality rates. Adoption of such policies may play a role in improving cardiovascular health among lower-income adults.
Potluri et al. (Mon,) studied this question.