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

Background & aims: Lacking access to quality food may increase the risk of MASLD. We investigated associations between food environment factors (food deserts and food swamps) and MASLD-related mortality across the United States (US).

Methods: MASLD-related deaths were obtained from the National Vital Statistics System (NVSS) (2016-2020) and food environment factors from Food Environment Atlas (FEA). 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 (4th quartile) compared to the lowest mortality quartile (1st 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 rates (30.2% vs. 18.5%), unemployment rates (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 socio-demographic and clinical factors and regions, mixed-effects linear regression models showed significant differences in mortality rates (per 100,000) between counties with the highest versus lowest quartiles of food deserts (25.65 vs. 12.75, adjusted difference = 3.66 [95% CI: 2.66-4.72]) and food swamps (27.13 vs. 20.15 per 100,000, adjusted difference = 3.57 [95% CI: 2.44-4.71]).

Conclusions: In the United States, addressing socio-demographic and food environment disparities is paramount to reduce MASLD-related mortality.