Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Cardiometabolic diseases including diabetes, hypertension, and obesity remain leading causes of morbidity and mortality in the United States and disproportionately affect communities across the southeastern region. In Georgia, disease burden is concentrated in rural counties and economically disadvantaged urban areas. Public health frameworks have traditionally attributed these disparities to limited physical access to healthy food, commonly described as “food deserts,” where distance to grocery stores is presumed to constrain dietary quality and worsen metabolic health. However, growing evidence suggests that economic food insecurity may play a larger role in cardiometabolic risk than geographic food access. Few studies have evaluated the relative contributions of these factors at a statewide spatial scale. This study examines whether food access or food insecurity better explains variation in cardiometabolic disease across Georgia census tracts.
Objective: To compare the relative contributions of physical food access and economic food insecurity to cardiometabolic disease prevalence across Georgia census tracts using statewide spatial data.
Methods: We performed a cross-sectional ecological study examining 2,783 census tracts across Georgia, with a focused case study of 15 tracts in Colquitt County. We used data from the USDA Food Access Research Atlas (2019), CDC PLACES modeled health estimates (2025), and demographic information from the 2022 American Community Survey. Because census tract boundaries shifted between 2010 and 2020, datasets were realigned using a population-weighted crosswalk from NHGIS prior to merging. Ordinary Least Squares regression with county-clustered standard errors and county fixed effects was used to compare physical food access (low-income, low-access share) versus economic food insecurity indicators as predictors of tract-level diabetes, hypertension, and obesity prevalence. Mediation analyses (Baron–Kenny framework), race × food insecurity interaction testing, and SNAP participation gap modeling were performed to explore potential mechanisms.
Results: Physical proximity to grocery stores showed no association with diabetes, hypertension, or obesity (R² < 0.01, p > 0.40). In contrast, economic food insecurity strongly predicted all three outcomes statewide (R² = 0.38–0.64) and explained 93% of tract-level diabetes variation in Colquitt County. Food insecurity mediated 67.7% of the Black–White diabetes gap, 61.6% of the obesity gap, and 36.9% of the hypertension gap. The smaller mediation fraction for hypertension suggests that factors beyond food insecurity contribute to hypertension disparities. Tracts with a higher percentage of Hispanic residents showed a weaker association between food insecurity and cardiometabolic disease, suggesting potential cultural or community-level factors that may buffer risk independent of economic deprivation.
Conclusion: Across Georgia census tracts, economic food insecurity was the dominant predictor of diabetes, hypertension, and obesity prevalence. Additionally, racial composition was associated with differences in baseline disease burden independent of food insecurity, highlighting the influence of broader structural determinants of health. Together, these results suggest that policies aimed at reducing cardiometabolic disparities should prioritize reducing food insecurity and addressing structural inequities rather than focusing solely on expanding supermarket access. As an ecological study using tract-level estimates, these findings describe population-level patterns and should not be interpreted as individual-level causal relationships.
Embargo Period
5-27-2026
Included in
Food insecurity as a primary driver of cardiometabolic disease across Georgia census tracts
Moultrie, GA
Introduction: Cardiometabolic diseases including diabetes, hypertension, and obesity remain leading causes of morbidity and mortality in the United States and disproportionately affect communities across the southeastern region. In Georgia, disease burden is concentrated in rural counties and economically disadvantaged urban areas. Public health frameworks have traditionally attributed these disparities to limited physical access to healthy food, commonly described as “food deserts,” where distance to grocery stores is presumed to constrain dietary quality and worsen metabolic health. However, growing evidence suggests that economic food insecurity may play a larger role in cardiometabolic risk than geographic food access. Few studies have evaluated the relative contributions of these factors at a statewide spatial scale. This study examines whether food access or food insecurity better explains variation in cardiometabolic disease across Georgia census tracts.
Objective: To compare the relative contributions of physical food access and economic food insecurity to cardiometabolic disease prevalence across Georgia census tracts using statewide spatial data.
Methods: We performed a cross-sectional ecological study examining 2,783 census tracts across Georgia, with a focused case study of 15 tracts in Colquitt County. We used data from the USDA Food Access Research Atlas (2019), CDC PLACES modeled health estimates (2025), and demographic information from the 2022 American Community Survey. Because census tract boundaries shifted between 2010 and 2020, datasets were realigned using a population-weighted crosswalk from NHGIS prior to merging. Ordinary Least Squares regression with county-clustered standard errors and county fixed effects was used to compare physical food access (low-income, low-access share) versus economic food insecurity indicators as predictors of tract-level diabetes, hypertension, and obesity prevalence. Mediation analyses (Baron–Kenny framework), race × food insecurity interaction testing, and SNAP participation gap modeling were performed to explore potential mechanisms.
Results: Physical proximity to grocery stores showed no association with diabetes, hypertension, or obesity (R² < 0.01, p > 0.40). In contrast, economic food insecurity strongly predicted all three outcomes statewide (R² = 0.38–0.64) and explained 93% of tract-level diabetes variation in Colquitt County. Food insecurity mediated 67.7% of the Black–White diabetes gap, 61.6% of the obesity gap, and 36.9% of the hypertension gap. The smaller mediation fraction for hypertension suggests that factors beyond food insecurity contribute to hypertension disparities. Tracts with a higher percentage of Hispanic residents showed a weaker association between food insecurity and cardiometabolic disease, suggesting potential cultural or community-level factors that may buffer risk independent of economic deprivation.
Conclusion: Across Georgia census tracts, economic food insecurity was the dominant predictor of diabetes, hypertension, and obesity prevalence. Additionally, racial composition was associated with differences in baseline disease burden independent of food insecurity, highlighting the influence of broader structural determinants of health. Together, these results suggest that policies aimed at reducing cardiometabolic disparities should prioritize reducing food insecurity and addressing structural inequities rather than focusing solely on expanding supermarket access. As an ecological study using tract-level estimates, these findings describe population-level patterns and should not be interpreted as individual-level causal relationships.