Volume 54 | Number S1 | February 2019

Abstract List

Aryn Z. Phillips MPH, Hector P. Rodriguez Ph.D., M.P.H.


To examine the relationship between food swamps and hospitalization rates among adults with diabetes.

Data Sources

Blue Cross Blue Shield Association Community Health Management Hub 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010‐2014.

Study Design

Cross‐sectional analysis of 784 counties across 15 states. Food swamps were measured using a ratio of fast food outlets to grocers. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Population‐weighted models were controlled for comorbidities; Medicaid; emergency room utilization; percentage of population that is female, Black, Hispanic, and over age 65; and state fixed effects. Analyses were stratified by rural‐urban category.

Principal Findings

Adults with diabetes residing in more severe food swamps had higher hospitalization rates. In adjusted analyses, a one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all‐cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care‐sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all‐cause hospitalization rate relationship was stronger in rural counties than urban counties.


Food swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity.