Cardiometabolic Dysregulation and the Social Determinants of Health in a Food Insecure Population: A Cross-Sectional Study

Background Cardiometabolic disease is a leading contributor to morbidity and mortality across the United States. While the relationship between food insecurity and cardiometabolic disease is well established, the extent to which neighborhood-level social determinants of health augment this relationship remains poorly understood. This study examines associations between neighborhood social determinants of health and cardiometabolic disease among food-insecure adults in Chicago, Illinois. Methods This cross-sectional study included adults attending a food pantry health screening from August 2023-June 2026. Participants were screened for cardiometabolic disease risk factors. Using self-reported zip code, neighborhood-level social determinant of health data was assigned for greenspace (Normalized Difference Vegetation Index), violent crime rate, and area deprivation (Area Deprivation Index). Associations between neighborhood exposures and cardiometabolic outcomes were examined using regression models adjusted for patient characteristics with standard errors clustered by zip code. Results Of the 582 participants 73.7% had hypertension, 21.3% had diabetes mellitus, 44.6% had obesity, and 67.4% had dyslipidemia. Nearly 65% of participants had two or more concurrent cardiometabolic conditions. Neighborhood exposures varied widely across zip codes with median normalized difference vegetation index of 0.39 (IQR: 0.31–0.51), median violent crime rate 25.8 per 1,000 (IQR 18.3–41.7), and median area deprivation index in the 43rd percentile (IQR 22nd -63rd ). No statistically significant associations were observed between primary neighborhood exposures (normalized difference vegetation index, violent crime, area deprivation index) and cardiometabolic outcomes (hypertension, diabetes mellitus, obesity, dyslipidemia). Conclusion This study demonstrates a substantial burden of both cardiometabolic disease and adverse neighborhood-level social determinants of health present among food-insecure individuals in Chicago. The absence of significant neighborhood associations may reflect the relative importance of food insecurity as a social determinant of health. These findings highlight the importance of community-based screening and integration of food security screening into primary care to facilitate early intervention.