title: Cardiometabolic Mortality by Supplemental Nutrition Assistance Program Participation and Eligibility in the United States.
abstract: OBJECTIVE
  To investigate total and cause-specific cardiometabolic mortality among Supplemental Nutrition Assistance Program (SNAP) participants, SNAP-eligible nonparticipants, and SNAP-ineligible individuals overall and by age, gender, race/ethnicity, and other characteristics.
  
  
  METHODS
  We performed a prospective study with nationally representative survey data from the National Health Interview Survey (2000-2009), merged with subsequent Public-Use Linked Mortality Files (2000-2011). We used survey-weighted Cox proportional hazards models adjusted for age and gender to estimate hazard ratios of total and cause-specific cardiometabolic mortality for 499 741 US adults aged 25 years or older.
  
  
  RESULTS
  Over a mean of 6.8 years of follow-up (maximum 11.9 years), 39 293 deaths occurred, including 7408 heart disease, 2185 stroke, and 1376 diabetes deaths. Individuals participating in SNAP exhibited higher total and cardiovascular disease mortality, largely limited to non-Hispanic Whites and non-Hispanic Blacks, than both SNAP-eligible nonparticipants and SNAP-ineligible individuals, and higher diabetes mortality across races/ethnicities (P < .01).
  
  
  CONCLUSIONS
  Participants in SNAP require greater focus to understand and further address their poor health outcomes. Public Health Implications. Low-income Americans require even greater efforts to improve their health than they currently receive, and such efforts should be a priority for public health policymakers.
authors.affiliation: All of the authors are with Tufts Friedman School of Nutrition Science and Policy, Boston, MA. Colin D. Rehm is also with the Office of Community and Population Health, Montefiore Medical Center, Bronx, NY.
authors.forename: Zach
authors.initials: Z
authors.lastname: Conrad
authors.affiliation: All of the authors are with Tufts Friedman School of Nutrition Science and Policy, Boston, MA. Colin D. Rehm is also with the Office of Community and Population Health, Montefiore Medical Center, Bronx, NY.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Rehm
authors.affiliation: All of the authors are with Tufts Friedman School of Nutrition Science and Policy, Boston, MA. Colin D. Rehm is also with the Office of Community and Population Health, Montefiore Medical Center, Bronx, NY.
authors.forename: Parke
authors.initials: P
authors.lastname: Wilde
authors.affiliation: All of the authors are with Tufts Friedman School of Nutrition Science and Policy, Boston, MA. Colin D. Rehm is also with the Office of Community and Population Health, Montefiore Medical Center, Bronx, NY.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D004608:Eligibility Determination; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States